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Over Two Decades Of Holding Insurance Companies Accountable

San Francisco Law Blog

Understanding ERISA denials and remedies

The basic concept of insurance is that it functions as a pooling of risk for policy holders and the insurer. Policy holders pay into a common fund to be drawn upon at a later date if needed. The money in the common fund belongs to policy holders and the insurer earns a fee for managing it. However, in application the insurer regards income generated from premiums as its own and works steadfastly to avoid returning it to policy holders. This means claims made by policy holders are often denied.

A compliant denial letter

What you should know about ERISA’s regulations

Navigating the many laws regarding disability insurance can be daunting. There are many complicated regulations to keep track of, which adds an extra layer of difficulty when you are also struggling with a disability.

One important law that is confusing for many disability claimants is The Employee Retirement Income Security Act (ERISA). Created in 1974, the act imposes standards and regulations on retirement, health and welfare benefit plans. When employers offer welfare benefit plans to their employees, ERISA sets certain standards that the employer must meet.

California wildfires continue to impact our state

Thomas, the historic California wildfire—the largest wildfire in California history—is fully contained after burning for over a month. With nearly $1.8 billion in insurance claims after the fires destroyed more than 1,000 structures and scorching 281,893 acres, the fire was devastating.

However, Thomas continues to impact our state. Beyond the issues of mudslides, air quality and watershed damage, property owners in fire-prone areas are finding it difficult to obtain affordable insurance. And in some cases, to find any insurance at all.

Three things common in insurance bad faith claims

Many California homeowners have been impacted by the devastating wildfires throughout the state this past fall. These homeowners will often have to file claims with their insurance companies in order to recover compensation under their policy in order to rebuild or repair their homes or property.

Unfortunately, many of these insurance companies will try to make it difficult for individuals to recover the money they are rightfully owed. They will deny the claims repeatedly in the hopes that the policyholders will simply give up.

What happens when insurers reject valid claims

An injury or property damage can be utterly devastating. Sure, you have an insurance policy against the risk that occurred. Unfortunately, your insurance company might let you down by acting in bad faith. In the shocking California wildfire, at least 42 people lost their lives, while thousands were left homeless. In the tragedy, more than 8,000 properties were razed to the ground by the fires.

California is a high-risk fire area, and most properties owners have their structures insured. AIR estimates that the insured losses from the fire outbreaks range between 2 and 3 billion dollars as of 26th October. Per the law and the policies, insurance companies, regardless of the losses suffered, are expected to investigate, negotiate and settle the claims with ultimate honesty or in good faith.

The basics of bad faith

When you enter into a contractual relationship with an insurance company, you expect that they will honor the terms contained in their policy. At the time you decide to accept their offer for coverage, they made promises to you that you would be protected in the event that something should happen.

Unfortunately, in many circumstances, insurance companies in a host of different industries often deny valid claims made by policyholders. They are hoping that you accept their answer of no and move on, without challenging them on their response.

What happens with long-term disability claims?

Many of us depend upon our jobs to provide us with the means to make a living. We create budgets and financial plans based upon the amount of money that we make each month. When we suffer an injury or illness that makes working impossible, we need to know what we can do to get the compensation we need in order to make ends meet.

If you suffer an injury or illness that is not workplace related, you will have to depend on your long-term disability insurance coverage in order to get benefits. You may purchase such insurance independently, or, you may have a plan that is provided by your employer. Depending upon the type of plan you have, different rules may apply to how the plan is carried out and how it may impact your situation.

Answers to your questions about long-term disability

Many clients come to us and have serious questions when they suffer from a disability that makes them unable to work. They have disability insurance, but do not know what that means or what that entitles them to receive from their insurers. In this post, we want to answer some of the most common questions that we get about long-term disability insurance.

 

What is long-term disability insurance?

We depend upon our jobs to provide us with the income to make ends meet. We may be the only ones who can perform certain tasks at the workplace. If we suffer an injury or illness that makes it impossible to perform these tasks, we could see a substantial loss of income due to our inability to work.

Long-term disability (LTD) insurance helps us recover compensation in order to make ends meet. These payments may exist for a limited period of time, or may run for the rest of our working lives. It all depends upon the type of coverage that we have from our employers or purchase from an insurer. In this post, we explain some basic information about LTD insurance, and what you should know if you run into problems with your policy.

9th Circuit case considers disability benefits

Recently, the 9th Circuit Court of Appeals released a decision that may have a significant impact upon long-term disability insurance matters in California. The ruling could potentially limit some of the power that insurance companies have to deny claims for benefits.

The case concerned a woman who worked for Boeing. As a benefit of employment, the employee was covered by a health and wellness plan provided to those who worked for the company. The plan had a clause that allowed Aetna, the insurance company that handled the health and wellness plan, substantial discretion when deciding whether or not an individual qualified as disabled.

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