• Private Disability Insurance Claim Denial Options
  • Private Disability Benefit Denial Options

Private Disability Denial

A private disability policy is one that is not governed by ERISA, because you either bought the policy on your own or you purchased the policy through your membership in association. If you have a private disability policy, then you have significant options available in the event your claim has been denied. Long term disability insurance denials are the kind of claims that can spiral out of control if not handled properly. Our disability attorneys have litigated against every major disability insurance company and have established a reputation for having what it takes to efficiently handle a disability denial yet we will take a case to trial if necessary. Our lawyers have been successful at obtaining hundreds of millions of dollars in long term disability benefits for our clients. We always attempt to use our well established relationships with the disability insurance companies to reach a resolution without the need to go through extensive litigation and trial. We only accept private claim denials on a contingency fee basis, which means we do not charge any fees or costs unless we are able to recover benefits. Our video above discusses available options for a private disability denial and our experience in handling these long term disability denials.

Our Extensive Disability Litigation Experience

We are not personal injury or social security lawyers that handle the occasional disability insurance claim. We are a team of ten attorneys and twenty-five staff that exclusively handle disability insurance claims nationwide. Each year we review hundreds of private disability benefit denials and only accept cases in which we believe we can achieve our client’s litigation goals. In the past 20 years, we don’t think there is another law firm that has handled more private disability denials nationwide than our law firm. Please select a disability company below for more information about your specific disability insurance company.

Videos, Questions, Resolved Cases, Lawsuit Summaries & Company Reviews

disability insurance companies complaints

We are one of the few law firms in the entire country that has taken a long term disability denial to trial. We have reviewed thousands of pages of internal company documents and taken depositions of claims examiners at almost every disability company in order to gain inside knowledge of these companies training manuals, claim handling techniques and internal operations. This is important because every disability insurance company understands our law firm’s legal capabilities and that tends to make the litigation process smoother and quicker for our clients. Disability denials often create financial hardships and we understand the importance of trying to get a disputed claim resolved in an expedient manner.

Depositions In Disability Litigation

  • Private Disability Insurance Claim Denial Options
  • Denial of Benefits With No Understanding of Occupation!
  • Doctor Refuses to Admit Claimant Has a Disability

When considering a law firm to your handle your private disability denial it is often difficult for a claimant to actually see how a lawyer performs in litigation or trial. In order to give potential clients confidence in our lawyers abilities we started publishing educational disability videos in 2010. We have produced over 400 disability insurance videos, but two of our favorite videos posted below are from video depositions we took of a claim manager at UNUM and a doctor that was hired by Metlife to support a claim denial.

Our Clients

We are always asked about our experience in representing individuals in specific occupations. When it comes to private disability denial claims the majority of our clients have been doctors, lawyers, dentist, chiropractors, business owners, high level executives, financial advisors, accountants, consultants and professional athletes. You can get a good understanding of the clients we have helped by reviewing our hundreds of client reviews and resolved case summaries. We also have client references available upon your request.

Private Disability Claim Denial Options

When an individual buys a disability income policy from an insurance company, the individual and the insurance company enter into a signed contractual agreement. If an individual is disabled according to the terms of the disability income policy, the carrier must pay the claim. A long term disability insurance denial is a breach of contract. If a disability insurance company has denied benefits to an insured, there may be multiple causes of action that can be alleged in a lawsuit against the insurance company. Each state has different laws and it is possible that some of the causes of action listed below may not be viable in the state where a claimant’s lawsuit must be filed. Attorneys Dell Schaefer has filed lawsuits against disability insurance companies in both state and federal courts throughout the country.

Breach Of Contract

The most common reason for denial of an insured’s claim for benefits is that the insurer has rendered an opinion that the insured is not "disabled” as defined by the subject disability policy. If the insured has been wrongfully denied benefits, the legal cause of action that may be filed against the insured is a first party breach of contract action. Similar to most first-party insurance cases involving a denial of benefits by an insurer, disability insurers are subject to actions for breach of contract. In order to prevail in an action for breach of a disability insurance contract the insured must prove the traditional common law elements for breach of contract:

  1. existence of a contract;
  2. a breach of the contract;
  3. damages resulting from the breach.

Additionally, in most cases, the burden of proof is on the insured to show:

  1. that he or she was regularly engaged in an occupation at the time of their disability;
  2. that he or she is disabled (either totally or partially);
  3. he or she is under the reasonable care of a physician qualified to treat them for their disabling condition.

Any lawsuit filed for breach of contract must have a copy of the disputed disability policy attached as an exhibit to the complaint. Most disability breach of contract actions involve questions of facts for the jury, therefore it is appropriate to demand a trial by jury in the complaint.

Breach Of Implied Covenant Of Good Faith And Fair Dealing

Every contract imposes upon each party a duty of good faith and fair dealing in its performance and enforcement. Under the law of most states, the implied covenant of good faith and fair dealing is a part of every contract. Asserting a claim of breach of implied covenant of good faith and fair dealing is often raised in first party disability insurance actions. Some insurance companies will move to strike an allegation of breach of the implied covenant of good faith and fair dealing on the basis that it is nothing more than a bad-faith claim in disguise. However, there is a clear distinction between an action for bad faith and alleging that the insurance carrier breached the implied covenant of good faith and fair dealing.

There are several important points that must be understood to properly allege breach of the implied covenant of good faith and fair dealing. It is important to note, that no independent cause of action exists for breach of the implied covenant of good faith and fair dealing. "Where a party to a contract has in good faith performed the express terms of the contract an action for breach of the implied covenant of good faith and fair dealing will not lie.” [A] claim for breach of the implied covenant of good faith and fair dealing cannot be maintained without identifying express contractual provisions that have been breached. In addition, the allegations pleading breach of the implied covenant of good faith and fair dealing should not be redundant where the conduct which forms the alleged violation is duplicative of the companion cause of action.

The implied covenant of good faith and fair dealing is limited in two ways: first, the claim must be accompanied by an allegation that an express term of the contract has been breached; and the implied obligation of good faith cannot be used to vary the terms of an express contract. Hence, to establish this cause of action, a plaintiff "must demonstrate a failure or refusal to discharge contractual responsibilities, prompted… by a conscious and deliberate act, which unfairly frustrates the agreed common purpose and disappoints the reasonable expectations of the other party, thereby depriving that party of the benefits of the agreement." Generally, the courts have been split on allowing the insured to plead breach of the implied covenant of good faith and fair dealing.

Fraud: Intentional Or Negligent Misrepresentation

An insured can plead an action for intentional misrepresentation against the disability insurer. In order to succeed in a claim for fraud or intentional misrepresentation against the disability insurer and/or the insurance agent, the insured must prove: "(1) a misrepresentation of a material fact; (2) which the person making the representation knew to be false; (3) that the misrepresentation was made with the purpose of inducing another person to rely upon it; (4) that the person relied on the misrepresentation to his detriment; and (5) that this reliance caused damages.” An allegation of fraud must be made with particularity. Where fraudulent misrepresentations were made by an agent of the insurer, both the agent and the insurer are liable. Furthermore, the insurer is estopped to deny coverage in accordance with the misrepresentations.

An insured or insurance company may also plead negligent misrepresentation. In order to succeed, the plaintiff must prove that: "(1) the defendant made a misrepresentation of material fact that he believed to be true but which was in fact false; (2) the defendant was negligent in making the statement because he should have known the representation was false; (3) the defendant intended to induce the plaintiff to rely… on the misrepresentation; and (4) injury resulted to the plaintiff acting in justifiable reliance upon the misrepresentation.

Intentional Infliction Of Emotional Distress

"A cause of action for ‘intentional infliction of severe mental or emotional distress,’ more appropriately called ‘outrageous conduct causing severe emotional distress,’ essentially involves the deliberate or reckless infliction of mental suffering on another, even if unconnected to any other actionable wrong.” An insurer need not intend to cause emotional distress to be subject to an action for intentional infliction of emotional distress; it need only be shown that the insurer "intended [its] specific behavior and knew or should have known that the distress would follow."

Fraudulent misrepresentations by the insurer or its agents can give rise to a cause of action for intentional infliction of emotional distress, as can the denial, delay and interference with medical treatment and the claims process. The key is that the conduct, when "[m]easured by the standards of human decency and societal expectations," would cause one to be outraged.

Breach Of Fiduciary Duty: Misrepresentations By Insurance Broker Or Agent

Under the law of most states, an insurance broker is in a fiduciary relationship with an insured. An insured may bring an action against his/her agent whose negligence causes the insured to become embroiled in litigation to secure coverage and incur attorney’s fees and costs.

Declaratory Judgment: Clarifying Policy Terms

In the disability insurance arena declaratory judgment actions are most often plead to clarify ambiguous terms in the disability insurance policy. "Questions of fact and disagreements concerning coverage under insurance policies are proper subjects for a declaratory judgment if necessary to construction of parties’ legal rights."  "Generally, declaratory relief is not available to settle factual issues upon which coverage questions turn under an insurance contract which is clear and unambiguous, because such instances present no need for contract construction or interpretation." Actions for declaratory judgment are appropriate when the Plaintiff is entitled to a declaration of rights. "To state a cause of action for declaratory relief, a complaint must allege that there is a bona fide dispute between the parties and that the moving party has a justifiable question as to the existence or non-existence of some right, status, immunity, power or privilege, or as to some fact upon which the existence of such right, status, immunity, power or privilege does or may depend, that plaintiff is in doubt as to the right, status, immunity, power or privilege, and that there is a bona fide, actual, present need for the declaration.

Some disability benefit denials do not require the filing of a lawsuit against the insurance company. In many cases our law firm will open the lines of communication with the disability insurance company and have a disability claim denial re-evaluated. Additionally, we can submit a detailed demand letter / appeal in response to the disability denial letter, which addresses the medical and legal issues and strengths of your claim, thereby giving the insurance company a last chance to pay disability benefits prior to the filing of a lawsuit. A disability denial letter must clarify all of the reasons that an individual disability claim has been denied.

In some cases we are able to mediate and meet with the insurance company prior to filing a lawsuit in order to reverse a disability claim denial without the need to file a lawsuit. These mediations take place at our office or a mutual location that is acceptable to our client. We participate is mediations throughout the country. In many cases a pre-suit mediation is a good alternative as it eliminates 18-36 months of wasteful litigation.

If our investigation of a long-term disability insurance denial reveals that the insurance company did not have a good faith basis for the LTD denial of our client’s claim, we will file a written complaint with the appropriate State Department of Insurance and Department of Finance. This action is required in most states in order to preserve a claim for bad-faith. Not every state allows a claim for bad-faith. Please watch our video below to learn about a bad faith claim for extra contractual benefits or go here for additional bad faith denial lawsuit information.

  • Bad Faith Disability Denials

Disability Class Action Lawsuits

In unique situations a disability class action lawsuit may be an option to pursue. Class actions in the disability insurance industry are unique because there must be a harm being caused that is universally affecting all class members the same. Most people that have a disability insurance claim are seeking individual disability benefits and a class action would not be the appropriate cause of action. Learn more about disability benefit class action lawsuits.

Questions About Hiring Us

Do you work in my state?

Yes. We are a national disability insurance law firm that is available to represent you regardless of where you live in the United States. We have partner lawyers in every state and we have filed lawsuits in most federal courts nationwide. Our disability lawyers represent disability claimants at all stages of a claim for disability insurance benefits. There is nothing that our lawyers have not seen in the disability insurance world.

What are your fees?

Since we represent disability insurance claimants at different stages of a disability insurance claim we offer a variety of different fee options. We understand that claimants living on disability insurance benefits have a limited source of income; therefore we always try to work with the claimant to make our attorney fees as affordable as possible.

The three available fee options are a contingency fee agreement (no attorney fee or cost unless we make a recovery), hourly fee or fixed flat rate.

In every case we provide each client with a written fee agreement detailing the terms and conditions. We always offer a free initial phone consultation and we appreciate the opportunity to work with you in obtaining payment of your disability insurance benefits.

Do I have to come to your office to work with your law firm?

No. For purposes of efficiency and to reduce expenses for our clients we have found that 99% of our clients prefer to communicate via telephone, e-mail, fax, GoToMeeting.com sessions, or Skype. If you prefer an initial in-person meeting please let us know. A disability company will never require you to come to their office and similarly we are set up so that we handle your entire claim without the need for you to come to our office.

How can I contact you?

When you call us during normal business hours you will immediately speak with a disability attorney. We can be reached at 800-682-8331 or by email. Lawyer and staff must return all client calls same day. Client emails are usually replied to within the same business day and seem to be the preferred and most efficient method of communication for most clients.

Dell & Schaefer Client Reviews   *****

Patricia T. (Florida)

If you think the insurance company is going to be FAIR, you are WRONG! Get an attorney, I recommend Dell & Schaefer. They entered my life approximately 4 years ago. I was in the mid years of my life, moving along routinely finishing up my 29th year of continuous employment as a professional Acute Care Registered Nurse, looking ahead to planning my future and possibilities ahead of me. I had planned to work at least another 15 years and maybe more if I could. I was hitting the peak of my value in the health system that employed me and I loved my job. Income was never an issue for me, as in my profession I could always find work and make as much income as I needed raising a family etc… But just incase, my father always taught me to have a safety net. So every year for 29 years, around benefit time I would fill out the forms and check the boxes for STD and LTD and pay the monthly dues for those policies in case I would ever need them, never expecting to use them. Well life had other plans for me.

My illness began slowly, I made adjustments to my work schedule and life schedule hoping that would allow me to stay employed. I didn’t want to give up the money, my benefits, the years experience I had, the value I had to contribute etc… That lasted for about a year and half then suddenly my body just couldn’t do it anymore. My illness exacerbated, necessitating me to leave work. I went out on my STD policy and initially Aetna the carrier of the policy was cooperative and approved my claim. After several months when I didn’t improve my STD policy was over and it was time to begin my LTD. At this point Aetna suddenly switched and began to deny all my claims for the same illness they had previously approved. I was shocked and bewildered, I could not believe how Aetna could be doing such a thing. What was happening, how could they just say NO! This wasn’t fair, I paid into this for 29 years… and was lost as to what to do.

I did some research on line, and found out this was a common thing all insurers were doing to people who had these kind of policies. What a rip off I thought. Here I thought I had a safety net. I was so angry and realised I was disillusioned about this system and having a safety net. I sat and cried fluctuating between anger, sadness, worry, the gamut of feelings. What should I do I thought, I need help and help fast. I couldn’t live without income. I did some more research and found Dell & Schaefer, I went through their website reading all the information and decided I need to call them to see if they could help me. My illness was not listed as a common illness for disability approval.

When I called them, they put me through immediately to someone and took some information. Later that day an attorney called me back and went through my situation explaining to me all my options and that they could help me. I wasn’t ready to make a decision on the spot, so I told them I would call them back. I was skeptical because at this point I didn’t trust anyone for numerous reasons and felt like all the systems I had faith in were failing me. Is this going to be another rip off, I thought?

After thinking about it for a day or two and consulting friends and family, I nervously called back Dell & Schaefer and I told them my concerns, we talked some more they never pressured me. I reluctantly agreed, not because of something they said, it was my own issue with trust now clouding my decision. Reflecting back that was the best decision I ever made. My attorney in the firm was Alex Palamara, I dealt with him exclusively and he always called me back, emailed me and let me know what was happening promptly. Nothing was ever too small for him to answer and he had compassion when I would complain about how unfair Aetna was being with their denial of my case. And YES, they did deny, and are still trying to find ways to deny me to this day 4 years later. Through the hard work and timely action taking by the attorney my appeal was reversed and my claim continues to be approved with the help of the attorney. I no longer have random calls from Aetna asking me repetitive questions that I already answered numerous times and the firm continues to coordinate the yearly reviews with Aetna and my physicians. I faced another denial at the two year mark when the policy changes the definition of gainful employment. Yea isn’t that beauty they sneak into the policy that you have really don’t understand. Alex anticipated that fought that and I have had a seamless benefit check now for 4 straight years.

I will not give up my representation, as educated as I am, in no way am I versed in disability law and the new ways insurance companies try to get out of paying the policy we have paid our hard earned money into for a safety net. I know things will not be easy and I will have to fight to continue my benefits, having Dell & Schaefer gives me security that someone will be there fighting for me and my benefits. I can’t thank them enough, I find them to be prompt, compassionate, knowledgeable and very fair with their fees. If you are thinking about hiring an attorney for representation you will be pleased with this firm. As a side note, my last years of employment I worked for a large hospital system, my job was coordinating with the hospital, physicians and Insurance companies to make sure the hospital would get paid. Specifically, I worked on denials of patients inpatient hospital bills. The insurance company would deny claims for the most unbelievable reasons. They know some people will just give up and not fight, that’s what they are counting on. I didn’t think they would do the same thing with STD and LTD policies, I was wrong and naive. Do yourself a favour, HIRE an attorney immediately from the beginning, otherwise the carrier will jerk you around till you give up, and you may inadvertently say or fill out a form wrong or miss a date and boom you are denied. You will never get your benefit you paid into. Hire Dell & Schaefer.

***** 5 stars based on 202 reviews

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