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Our services
Process
Our legal methodology is a structured, evidence-driven process designed to build an incontestable case. It begins with a thorough review of your insurance policy, medical records, and the insurer's denial letter to identify contractual breaches or bad faith. We then collaborate with medical and vocational experts to prepare detailed assessments that counter the insurer's arguments. A critical step is the administrative appeal, which must often be exhausted before litigation and has strict deadlines, typically 180 days from denial. We meticulously compile all evidence, including new medical opinions and functional capacity evaluations, to demonstrate your disability meets the policy's specific definition. If the appeal is denied, we are prepared to file a lawsuit in federal or state court, leveraging discovery to uncover the insurer's internal decision-making process.
At a Glance
| Parameter | Reference Value |
|---|---|
| Administrative Appeal Deadline | Typically 180 days from denial |
| Common Policy Definitions | "Own Occupation" vs. "Any Occupation" |
| Key Governing Law | ERISA (Employee Retirement Income Security Act) |
| Litigation Venue | Federal or State Court |
Local Considerations — USA
Disability insurance law practice varies significantly across the United States due to differing state regulations and federal oversight. The majority of employer-provided group disability plans are governed by the federal ERISA statute, which preempts state law and imposes specific procedural requirements. However, individual disability policies and some employer plans may fall under state contract and insurance bad faith laws, which can offer more favorable remedies. Our national practice is adept at navigating this complex landscape, whether handling an ERISA claim that requires exhausting administrative remedies or pursuing a bad faith claim under California or New York state law. This jurisdictional expertise is crucial, as seen in major tech hubs like San Francisco where high-income professionals often face disputes over "own occupation" definitions.
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Standards & Compliance
- ERISA (Employee Retirement Income Security Act)
- State Insurance Bad Faith Laws
- Policy-Specific Contractual Terms
- Department of Labor Regulations
Frequently Asked Questions
What is ERISA and how does it affect my disability claim?
ERISA is a federal law governing most employer-sponsored benefit plans, including group disability insurance. It sets strict procedures for appeals and litigation, often limiting evidence to what was submitted during the administrative review and applying a more deferential standard of review to the insurer's decision, making expert legal guidance essential.
What is the difference between 'own occupation' and 'any occupation' disability?
"Own occupation" means you are disabled if you cannot perform the material duties of your specific job. "Any occupation" is a stricter definition, meaning you are not disabled if you can perform duties of any job for which you are reasonably qualified. The specific language in your policy dictates which standard applies and when.
How long does the disability insurance claims process take?
Timelines vary. The internal appeal process with the insurer can take several months. If litigation becomes necessary, a case can take one to three years to resolve, depending on the court's docket and complexity. Each listed firm works to streamline each phase while building the strongest possible case for a favorable outcome.
How much does a disability insurance claim case cost in the USA?
Legal fees for disability insurance claims are typically handled on a contingency basis, meaning each listed firm is paid a percentage of the recovered benefits only if we win your case. This structure aligns our interests with yours and provides access to legal representation without upfront costs. Specific terms are detailed in a retainer agreement.