Unfair Disability Insurance Claim Denials: How to Take Legal Action Against Your Insurer
On Behalf of Disability Insurance Law Group | | Denied Disability Insurance ClaimFiling a disability insurance claim should provide financial relief when you cannot work due to a medical condition. Unfortunately, many insurance companies deny valid claims, leaving policyholders without the promised benefits.
If your disability claim has been unfairly denied, you have legal options to fight back and seek the benefits you deserve. Here, our nationwide claims attorneys at Disability Insurance Law Group explain how to take legal action against your insurer after an unjust denial.
Why Are Disability Insurance Claims Denied?
Insurance companies frequently deny disability claims for various reasons, many of which are tactics designed to avoid paying benefits.
Common reasons include:
- Insufficient Medical Evidence – The insurer claims your medical records do not support your disability.
- Failure to Meet the Policy’s Definition of Disability – Some policies require that you prove you cannot work in any job other than your previous occupation.
- Pre-Existing Condition Exclusions – The insurer argues your condition existed before coverage began.
- Missed Deadlines – Strict filing and appeal deadlines must be met, which can lead to automatic denial.
- Surveillance or Social Media Evidence – Insurers may use video surveillance or your social media posts to claim you are not as disabled as you say.
- Bad Faith Insurance Practices – Some companies delay processing claims, fail to conduct thorough investigations, or repeatedly request unnecessary information to frustrate policyholders into giving up.
If your claim has been denied for any of these reasons, it is critical to take the proper steps to challenge the decision.
Steps to Take After an Unfair Disability Insurance Denial
A disability insurance denial is not the end of the line. While a denied claim can feel overwhelming, it does not mean you have to accept the insurance company’s decision. There are clear steps you can take to fight back, strengthen your case, and pursue the benefits you deserve. By understanding your rights and taking the proper legal actions, you can challenge an unfair denial and hold your insurer accountable.
- Review the Denial Letter Carefully
Insurance companies must provide a written explanation of why they denied your claim. Carefully review this letter to understand the insurer’s reasoning and determine what additional evidence you may need.
- Request Your Claim File
Under the Employee Retirement Income Security Act (ERISA), you have the right to request a copy of your entire claim file if your policy is employer-sponsored. This file contains the insurance company’s internal notes, medical evaluations, and all documents used in their decision-making process. Reviewing it can help you identify weaknesses in your argument.
- File an Appeal
If ERISA governs your policy, you typically have 180 days to file an administrative appeal. This appeal is crucial because ERISA often prevents claimants from introducing new evidence in court.
Your appeal should include:
- Additional medical evidence supporting your disability.
- Expert opinions from doctors, vocational experts, or other specialists.
- A detailed rebuttal of the insurer’s reasons for denial.
For individually purchased policies, appeal deadlines vary, so reviewing your policy’s terms is essential.
Take Legal Action Against the Insurer
You may need to file a lawsuit against the insurance company if your appeal is denied.
The process depends on whether your policy is ERISA-governed or a private policy:
- ERISA Policies – Lawsuits must be filed in federal court, and you must prove the insurer arbitrarily denied your claim.
- Private Disability Policies – Lawsuits are handled under state insurance laws, and claimants can present evidence and argue bad-faith insurance practices more flexibly.
Work With an Experienced Disability Insurance Attorney
Insurance companies have legal teams dedicated to protecting their profits. Hiring an attorney levels the playing field and ensures your claim is handled correctly.
A skilled disability insurance lawyer can:
- Gather compelling medical and vocational evidence.
- Challenge the insurer’s bad-faith tactics.
- File a lawsuit if necessary to recover your benefits.
Get Legal Help to Fight an Unfair Denial
If your disability insurance claim has been unfairly denied, you don’t have to navigate the appeals process alone. At Disability Insurance Law Group, we represent policyholders nationwide and fight back against insurance companies that refuse to honor valid claims. Contact our nationwide disability insurance claims attorneys at 954-989-9000 or online today for a free consultation, and let us help you get the benefits you deserve.