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Some disability insurance policies include a provision that the insurer will try to use to disregard the insured’s actual job duties in deciding whether the insured is disabled.  A number of these policies, especially those sold by Standard Insurance Company, contain language that states that, in deciding whether to pay the claim, the insurer can […]

In the recent case of Backman v. Unum Life Ins. Co. of Am., 2016 U.S. Dist. LEXIS 74918 (N.D. Cal. June 8, 2016), in which the claimant sought disability benefits for a painful back injury, the US District Court for the Northern District reversed Unum’s denial and ordered the payment of benefits. Unum had denied benefits based on the opinions […]

In ERISA claims, disability insurance companies often state in their denial letters that the insured does not qualify for benefits because he has not stated “objective evidence” of disability. However, case law in the 9th Circuit and elsewhere is clear that an ERISA insurer cannot properly insist on proof with “objective evidence” if the condition is one for which […]

If your insurance company denies your disability insurance claim and your case is governed by California law, proving “bad faith” is a two-step process. You must first establish that you are disabled under California law. In other words, you must first establish that, under California law, you are entitled to the disability benefit under the […]

If your insurance company has denied your disability insurance claim and your claim is governed by California law, you must establish that you are disabled under California law. Whether your policy requires that you establish that you are “disabled” or “totally disabled,” the same definition should apply. California law supersedes the definition in your policy […]

There are key deadlines to meet if you intend to sue your insurance company. Unless the insurance company has inserted an enforceable provision in the policy limiting the time within which you may sue and, secondly, it is not unfair under the circumstances for the insurance company to impose this shorter deadline, you must file […]

Insurance companies use a “vocational expert” to assist them in denying claims. Rather than assess whether the policyholder is able to perform his or her actual job as reflected in an accurate job description or a fair analysis of the actual functional requirements of the job, the “vocational expert” is enlisted to redefine the policyholder’s job. By redefining the […]

The insurance company doctor is an essential cog in the insurance company’s denial mechanism. The insurance company doctor typically writes a memo or report on which the insurance company purports to base its claims decision. Techniques that an insurance company doctor commonly employs to assist the insurer in denying claims include: (i) asserting erroneously that […]

A technique essential to an insurance company in denying claims is the hiring of a physician consultant on whom it can rely to support its denial. Unlike the treating physician, most of these insurance company physicians never see or speak with the policyholder. Most only perform a “paper review.” Most disregard the reasoned and informed […]

One of the techniques an insurance company employs to deny a claim or buttress its intended denial is known affectionately by insurance companies as the “Doc-to-Doc” interview. Under the guise of “reaching out” to the treating doctor to seek his opinion in order to fairly decide a claim, a claims person or the physician hired […]