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Dawson and Rosenthal
Dawson and Rosenthal

San Diego Disability Insurance Claim Denials and Delays

A claimant relies on disability insurance when he or she is especially vulnerable. In exchange for payment of premiums, a policyholder reasonably expects a timely issuance of benefits when he or she needs it most. Unfortunately, insurers will employ a variety of tactics to delay or deny claims for disability. Many of these tactics are illegal under California law.

If you believe your insurance company is acting in bad faith concerning your disability claim, you may have legal grounds for a claim against them. Contact the lawyers at Dawson & Rosenthal, P.C. to schedule a free review of your legal options today. For five decades, California residents have been choosing our firm to represent them in their time of need:

  • We only take on a few cases at a time, which means we can give your case the undivided attention it deserves.
  • Our firm only works with bad faith insurance law, which gives us a superior depth of experience.
  • We offer our services on a contingency-fee basis, which means you’ll only owe attorney’s fees if we win a settlement or court judgment on your behalf.

Common Causes for Disability Insurance Claim Denials and Delays

Insurance companies may deny or delay claims for several reasons, but some are more common than others. Additionally, only some of them are legal or based on sound evidence. Some of the most common causes of disability insurance claim denials and delays include:

  • Lack of hard medical evidence. Sometimes, an insurance company will deny a claim because a medical provider fails to document how an injury disrupts a person’s quality of life or ability to do his or her job.
  • A previous denial on record. Many people believe filing a new disability claim will be better than trying to appeal a previous one. Unfortunately, this may only lead to an additional denial.
  • Failure to follow a prescribed treatment plan. In some cases, an insurer may refuse to pay a claim because it believes a person is not following a doctor’s orders to recuperate.

Disability Insurance Claim Denials and Delays and Bad Faith Insurance

Some grounds for disability claim denials are legitimate, while others constitute bad faith. Insurance companies have a duty to put the interests of a policyholder above its own profits. Additionally, it must try to find evidence to support a claim, not to deny it.

An insurance claim denial or delay may arise to insurance bad faith when the following elements apply:

  • An insurance company fails to conduct a thorough investigation into a claim.
  • It makes unreasonable or unnecessary claims for additional evidence to support a claim.
  • It coerces a claimant into making statements that support a denial.
  • It underpays on an insurance claim without explanation.
  • It fails to disclose policy limits or other pertinent information.

Proving Insurance Bad Faith in Disability Claim Denials

It can be difficult for the average person to prove insurance bad faith has occurred following a disability claim. A claimant has a right to file an appeal and request an explanation for the claim denial. Once he or she exhausts these avenues, it’s time to turn to other options.

When an insurance company acts in bad faith, a policyholder may be able to pursue legal recourse against the company to demand fair payment on a claim, as well as accrued interest and possibly punitive damages. Doing so requires the guidance of an attorney. At Dawson & Rosenthal, P.C. our sole practice is bad faith insurance law. We readily identify instances of bad faith dealing and hold the responsible parties accountable for their actions. Contact us to discuss your legal options in a free initial consultation today.