http://www.yourlawyer.com/topics/overview/disability_claim_denial Sat, 21 Nov 2009 04:19:41 -0800 pixel-app en http://www.yourlawyer.com/articles/read/17058 Wed, 30 Sep 2009 00:00:00 -0700 http://www.yourlawyer.com/articles/read/17058 disability claims handling violations.  Under the terms of the settlement, Life Insurance Company of North America will pay a $600,000 fine, make changes in its claims handling policies and procedures, and review previously closed claims to determine if additional benefits are due.

The settlement stems from an onsite examination of Life Insurance Company of North America's claims handling practices conducted by the California Department of Insurance.  According to a press release issued by the Department, instances were found where Life Insurance Company of North America had made claims determinations prior to requesting medical records and examples of the company's adjusters ignoring substantial new information after a claim had initially been denied. As part of the settlement, Life Insurance Company of North America has agreed to make significant improvements to its claims handling practices in order to avoid future violations, the press release said.  

In addition to the $600,00 penalty, the settlement calls for Life Insurance Company of North America to cease and desist from engaging in any acts or practices in violation of California law. Life Insurance Company of North America's revised claims handling practices are designed to avoid the type of violations alleged.  The Department will provide oversight to assure that this goal is being met. Under the agreement, Life Insurance Company of North America will also review all California resident closed denied claims for the period January 2005 through December 2007 using the agreed upon quality standards outlined in the settlement.

"Individuals purchase long term disability insurance to protect themselves and their families in the event they become disabled and are unable to work," said California Insurance Commissioner Steve Poizner. "When insurance companies fail to follow the law in fairly and expeditiously adjusting these claims, it has a devastating impact on policyholders and their families. I am pleased that LINA (Life Insurance Company of North America) has taken responsibility for its actions and has implemented changes in its policies, procedures and practices. The Department will continue to monitor the actions of all insurers selling and marketing disability insurance in the state of California."

]]> http://www.yourlawyer.com/topics/overview/disability_claim_denial Wed, 30 Sep 2009 00:00:00 -0700 http://www.yourlawyer.com/topics/overview/disability_claim_denial Disability Claim Denial Many policyholders have heard the same excuses as to why their claims have been denied. Excuses have ranged from failing to receive documentation on time, failing to receive medical reports; ailment is not a covered disability and more. Disability insurance companies have historically refused benefits to policyholders Or, the insurance company may allege that the pain is not severe enough to prevent the employee from working. Recent studies prove them wrong, yet benefits are still often initially denied and require an attorney’s assistance to recover them.

Professional disability insurers have been found liable for denying coverage on claims brought by disabled professionals. In the 1970s and 1980s some of these insurers grossly oversold disability policies to younger professionals, anticipating that few claims would mount from this low risk population. However as the policyholders aged and professionals became disabled, the claims mounted steadily. Some of the companies decided to cope by unfairly denying claims to cut their losses.

Bad faith claims are basically a breach of the insurance contract, when insurers use non-legitimate reasons to deny claims. Insurers have a duty to the insured to examine claims in good faith and use fair dealing when evaluating claims. To act in bad faith requires the insurer to engage in unfair dealing not just a mistake.

Most lawsuits involve action against an insured's own insurance company, and arise in situations where the insurance company unfairly and without proper cause, fails to compensate the insured for a loss covered by the policy, or unreasonably delays making payments due under the policy.

If your insurance company has denied your claim, please fill out the form at the right for a free case evaluation by a qualified disability claim denial attorney.]]>