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Under California law, a private citizen can bring a lawsuit specifically intended to address the ills or injustices in society.  Recognizing that such lawsuits are highly risky and may be prohibitively expensive, in 1977, California passed a law often referred to as the Private Attorney General’s Act (“PAGA”).  Under PAGA, found at California Code of […]

When an insurance company denies a claim, it will often summarize in its denial letter the evidence cited by the insured in support of the claim.  The insurance company will do so in order to attempt to create an appearance that it actually reviewed and considered in good faith the evidence contrary to its decision.  […]

California case law is clear that an insured’s attempt to return work may not bar a finding of disability.  The California courts have long recognized that people who are struggling with pain and other symptoms will nevertheless attempt to work.  In recognizing that people may continue perform job duties that endanger their health, courts have […]

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 […]