When you’ve paid your insurance premiums and counted on your policy to protect you in times of need, having your long-term disability claim denied can feel like a profound betrayal. But what recourse do you have? Can you sue your insurance company for denying your claim? In San Diego, as in the rest of California and the United States, the answer is yes. Let’s delve deeper into when and how you can take legal action against your insurance company following a denial of your long-term disability claim.

Understanding the ERISA Regulations

Most group long-term disability policies are governed by the Employee Retirement Income Security Act (ERISA). This federal law includes provisions that allow policyholders to sue their insurance companies for denying their disability claim, but only after they’ve exhausted their policy’s internal appeal process.

Exhausting Internal Appeals

Before you can file a lawsuit, you must go through the insurance company’s internal appeal process. This involves submitting a request for the company to reconsider its decision, often accompanied by additional medical evidence or documentation. Usually, you have 180 days from the date of your denial letter to file an appeal.

Litigation under ERISA

If your appeal is denied and you’ve exhausted all internal avenues for resolution, you can then file a lawsuit in federal court. Your lawsuit must demonstrate that the insurance company’s decision was arbitrary and capricious, meaning that no reasonable person would have reached the same conclusion given the available evidence.

Non-ERISA Policies and Bad Faith Lawsuits

For disability policies not governed by ERISA, such as private or individual policies, you might have additional options, including the right to sue the insurance company for acting in bad faith. California law requires insurance companies to treat their policyholders fairly and in good faith. If they deny a claim without a valid reason, delay processing a claim, or fail to conduct a proper investigation, they may be acting in bad faith.

The Importance of Legal Representation

Disability law can be complex, and navigating the appeal process and potential litigation requires expertise. Having a seasoned long-term disability attorney, like those at Bonnici Law Group, is crucial to ensure your rights are protected and to maximize your chances of a successful outcome.

In conclusion, yes, you can sue your insurance company for denying your long-term disability claim in San Diego. However, this step should only be taken after careful consideration and under the guidance of a skilled attorney. At Bonnici Law Group, we’re committed to fighting for your rights and helping you get the benefits you deserve. If your long-term disability claim has been denied, don’t hesitate to reach out to us. We’re here to support you through each step of the process. Call us at (619) 259-5199, or click here for a free consultation.