Insurance Law: The area of law that emcompasses federal laws and state statutes governing the insurance business.
Insurance companies routinely look for reasons to deny claims. Each claim not paid adds to the insurance company's profit. A typical method for reducing claim payouts is for an insurer to find incorrect or incomplete information on the life insurance application. Such refusal to pay often constitutes a breach of contract and in violation of California laws prohibiting insurers from acting in bad faith.
Life Insurance Attorneys
A life insurance policy is a contract between a policyholder and an insurance company. Consequently, when facts come to light that an insurer believes violates the terms of a policy, they often claim they have the right to deny coverage. The issue, however, is determining whether or not an alleged violation actually constitutes a violation of contract terms.
Insurers companies often focus on extraneous terms in an effort to rescind a life insurance policy. When these actions are immaterial to the cause of death, a breach of contract has likely occurred. For example, an insurer may deny a death claim on an insured that died in a car accident but did not indicate on his original policy that he was a smoker. Here, the insurer might argue that the policy was voided by false information. However, the alleged misrepresentation must be considered material under California law for the insurance company to rescind the policy and void life insurance coverage. Further, even a material misrepresentation may not void coverage if the two year period of contestability has expired.
By employing such tactics, insurance know that many claimants will simply give up, either unaware of their legal rights or reluctant to consult an attorney. Or they may convince an unrepresented claimant to settle for pennies on the dollar.
If you need help in collecting life insurance funds, our attorneys have the litigation experience to help you prevail against the insurance company. Please contact us for a free referral and consultation with a pre-screened Insurance attorney 800-723-1391.
Los Angeles ERISA Attorneys
The specific appeals and grievance procedures that apply, and the extent and nature of legal remedies available, vary significantly from state to state, company to company, and often depend upon whether the health insurance or plan is or is not one covered by the Employee Retirement Income Security Act of 1974 (ERISA), as amended by the Multiple Employer Pension Protection Act of 1980 (MEPPA), typically collectively referred to as ERISA.
The original noble idea behind this federal law was protection of employee benefits and pension moneys from mismanagement or theft by incompetent or greedy trustees or by organized crime. Unfortunately, except for state laws that actually regulate insurance companies or health plans, ERISA preempts (eliminates) any state law or remedy for insured or plan members that might otherwise relate to health care insurance benefits, obtained through employment. In other words, as a practical matter, if a claim for health benefits or service is denied to a person who obtained health insurance coverage through employment, they are limited to the appeals and grievance procedures in the policy or plan and cannot sue in court for such things as breach of contract, breach of the implied covenant of good faith and fair dealing (bad faith), infliction of emotional distress, fraud, etc..
Typically, if the policy or plan is governed by ERISA, the only legal remedy outside of the policy or plan is to ask a court to review the claim denial decision to see if there was an abuse of discretion, which is extremely difficult to establish. Even if an abuse of discretion is established, the claimant is only entitled to receive the benefit or service that was originally denied, and that is often too late to help. In contrast, if the plan is an insured plan, and NOT subject to ERISA, the Insurer's Bad Faith can give rise to punitive damages.
Nearly 70% of the health care insurance currently in place in the United States is subject to ERISA. The balance of the health insurance in America is not subject to ERISA. The primary exceptions from ERISA are any health insurance policies or plans issued to individuals, and any group health insurance or plan coverage for employees of any state or local governmental agency or district, and any employee of a church or church affiliated organization. In addition, ERISA may not apply even if the health insurance coverage is obtained through private employment if the following four factors all apply: (1) the employer or employee organization did not contribute in any way to or any portion of premiums, (2) the participation in the employee benefit plan or program was voluntary, (3) the employer or employee organization did not endorse or administer the insurance and, (4) the employer or employee organization did not receive any commission or participation fee in connection with the insurance program or plan.
ERISA Disability Attorney
The Employee Retirement Income Security Act ("ERISA") usually governs most long term disability claims that are filed under a group policy obtained by your employer. When ERISA applies, you have a full range of legal rights that should be vigorously pursued in order to maximize your chances of success. On the other hand, there are many hidden dangers in ERISA that a disabled claimant must prepared for, plan against and protect against.
An ERISA appeal is a complex and multifaceted set of materials that must be compiled, written, and submitted in order to maximize the chances of success on a long term disability insurance claim. Most people do not know that if an ERISA appeal is not successful and a lawsuit is necessary, a federal court may not be able to review any other materials other than the insurance company's file and the contents of your ERISA appeal.
An pre-screened ERISA disability lawyer makes certain that the appeal takes into account all of the medical information, vocational information, medical records, statements of witnesses and all other legal arguments and issues that make a difference in the results we obtain. In addition, these materials and legal arguments are preserved for future consideration by a court, if a lawsuit is ultimately necessary. Our attorney's success rate on ERISA appeals is unparalleled because they invest the time and effort in obtaining success at the stage of the ERISA appeal, to avoid future litigation for the client.
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