The letter says you are capable of working. Your doctor, your body and your last six months say otherwise.
Bonnici Law Group is a long term disability insurance lawyer practice that takes on insurers across California when they deny, delay or cut off benefits under a policy you paid into. We handle claims under employer group plans and under private individual policies, and the difference between those two changes almost everything about how your case is built.
Managing attorney Josh Bonnici has handled long-term disability claims for more than a decade against carriers including Prudential, Hartford, Liberty Mutual, Lincoln Financial and MetLife.
Call 619-259-5199 for a free claim review.
Table of Contents
- Does Bonnici Law Group Handle Disability Claims Outside San Diego?
- Why Do Insurers Deny Claims That Look Obviously Valid?
- Why Does Disagreeing With a Denial Almost Never Work?
- Is Your Policy an ERISA Plan or a Private Policy?
- What Does a Strong Disability Appeal Actually Contain?
- How Long Do I Have to Appeal a Long-Term Disability Denial?
- Why Do Benefits Get Cut Off After Two Years?
- What Does This Firm Do Differently on a Disability Claim?
- When Should You Call a Long-Term Disability Lawyer?
- What Does It Cost to Hire a Disability Attorney?
- Long-Term Disability Questions California Clients Ask
- Your Policy Already Promised This
Does Bonnici Law Group Handle Disability Claims Outside San Diego?
Yes. Long-term disability work is one of two areas where we represent clients throughout California rather than only in the San Diego region. The office is in downtown San Diego, and disability clients come to us from across the state.
That reach exists because these claims are largely built on paper. Policy language, medical records, vocational evidence and a written appeal do not require you to live down the street from your attorney.
Why Do Insurers Deny Claims That Look Obviously Valid?
Most denials come down to one argument dressed up several different ways: the insurer says your records do not meet the definition of disability written into your policy. Not that you are healthy. Not that you are lying. That the paperwork does not go far enough.
That framing matters, because it tells you what an appeal has to do. Restating how you feel does not answer it. Showing that the carrier took too narrow a view of the evidence, or skipped over what the records actually say, does.
The definition of disability is the whole fight
Policies usually pay for an initial period when you cannot perform your own occupation, then switch to a stricter standard where you must be unable to perform any occupation you are reasonably suited for.
That switch, often at the twenty-four month mark, is where a claim that was being paid without complaint suddenly gets reviewed and terminated. The claim did not change. The definition did.
Objective evidence carries more weight than it should
Conditions that show up cleanly on a scan or a test tend to move through the process. Conditions built on symptoms, pain levels and function tend to draw a fight, because the carrier can argue the file lacks measurable proof.
That is not a reason to give up on a claim. It is a reason to build the file differently from the start.
Why Does Disagreeing With a Denial Almost Never Work?
Because an appeal that says you disagree is not an appeal in any meaningful sense. It is a letter. Under most disability policies and under federal law, the appeal is your one chance to build the record, and a record that adds nothing new gives the carrier no reason to change its answer.
This is the single most common mistake we see, and it is usually made by people acting in good faith. They read the denial, they know it is wrong, and they write back saying so.
What moves a claim is new evidence. Updated treatment records. A physician statement that speaks directly to the policy language rather than to a diagnosis. Function measured against what the job actually demanded. Statements from people who watched the decline happen.
Once the appeal closes, a court reviewing an employer plan is generally limited to the record that was built during the appeal. Evidence you did not submit then usually cannot be introduced later. If you are at this stage, read our page on appealing a long-term disability denial before you send anything.
Is Your Policy an ERISA Plan or a Private Policy?
If you got the coverage through your employer, it is almost certainly governed by ERISA, the federal Employee Retirement Income Security Act. If you bought it yourself from an agent or through a professional association, it is probably a private individual policy governed by California law.
The two paths barely resemble each other.
| Employer group plan (ERISA) | Private individual policy | |
|---|---|---|
| Governing law | Federal ERISA rules | California insurance and contract law |
| Mandatory internal appeal | Yes, before any lawsuit | Usually not required |
| Discovery in litigation | Very limited, often confined to the claim file | Full state court discovery |
| Jury | No | Available |
| Damages beyond benefits | Generally unavailable | Bad faith damages possible |
| Offsets against benefits | Broad, and common | Narrower, policy dependent |
Most people find out which one they have after they are already denied. Knowing it at the start changes when evidence gets submitted, what gets preserved, and whether there is any leverage beyond the benefits themselves.
Our page on ERISA-governed disability claims goes deeper into how courts review these decisions and why the standard of review often decides the case.
What Does a Strong Disability Appeal Actually Contain?
A strong appeal answers the denial letter point by point with evidence the carrier has not seen. It is a submission, not a protest, and it is usually the last opportunity to put anything into the record at all.
Medical proof written against the policy language
A letter saying you are disabled rarely moves a file. A statement from a treating physician that identifies specific findings, describes specific limits on sitting, standing, lifting, concentration or attendance, and connects those limits to the exact wording your policy uses is a different document entirely.
Carriers write denials in policy terms. Appeals that answer in medical terms alone talk past them.
Evidence of what your job actually required
Occupational duties get flattened into a job title somewhere in the process, and the title almost never captures the work. A claim reviewed against a generic desk job description when the actual role involved constant travel, physical labor or sustained concentration is being measured against the wrong standard.
Vocational evidence, employer job descriptions and, where appropriate, a vocational assessment put the real demands back into the file.
The carrier's own file
You are entitled to a copy of the claim file for an employer plan, and what is in it matters. Reviewer reports, surveillance, internal notes, and the credentials of the physician who evaluated your records are all fair territory. Denials built on a paper review by a doctor who never examined you are common, and the file is where that becomes visible.
Statements from people who watched it happen
Supervisors, coworkers, family members and friends describe function in a way medical records do not. A colleague explaining that you stopped being able to finish a shift six months before you stopped working fills a gap no chart note covers.
How Long Do I Have to Appeal a Long-Term Disability Denial?
At least 180 days from the date you receive the denial, if your plan is governed by ERISA. That deadline comes from the federal claims procedure rule at 29 C.F.R. 2560.503-1, published by the U.S. Department of Labor.
The same rule sets the insurer's clock. On an initial disability claim the plan generally has 45 days to decide, with two possible 30 day extensions. On appeal it has 45 days, with one 45 day extension for special circumstances.
The deadline nobody warns you about
Separate from the appeal window, most policies contain their own contractual time limit for filing a lawsuit. The U.S. Supreme Court held in Heimeshoff v. Hartford Life & Accident Insurance Co. that these provisions are enforceable, and that the clock can start running from the date proof of loss was due rather than from the denial.
Read that twice. It means the deadline to sue can begin running while your administrative appeal is still open, and in some cases can expire before the appeal even finishes. The plan document controls, and the period varies.
This is a specific, checkable thing, and it takes one reading of your policy to find. If nothing else on this page moves you, that should.
Call 619-259-5199 and we will look at your denial letter and your policy at no cost.
Why Do Benefits Get Cut Off After Two Years?
Because most group policies limit benefits for disabilities caused by mental health or substance use conditions to twenty-four months, no matter how disabling the condition remains. A 2023 report by the U.S. Department of Labor's ERISA Advisory Council found that roughly 99 percent of group long-term disability policies contain such a limitation.
Two things follow from that. First, the termination letter you received at month twenty-four may have had nothing to do with your medical status. Second, how a condition is characterized in your file can decide whether that limitation applies at all.
A claim documented primarily through a psychiatric diagnosis and a claim documented through the physical condition underlying it can end very differently, even for the same person. That characterization is worth attention early, not after benefits stop.
What Does This Firm Do Differently on a Disability Claim?
We put the claimant in front of the carrier instead of describing them on paper. Josh Bonnici often takes a video-recorded, under-oath statement from the client and submits it with the appeal, so the decision-maker hears the person explain what a day actually looks like now.
Carriers are accustomed to reading physician narratives and attorney argument. They are not accustomed to watching their own insured answer questions under oath. It does not win a claim by itself, and it reframes one that has been reduced to a file number.
Alongside that, an appeal we build typically includes treating physician statements written against the policy language, employment and vocational detail about what the job required, and statements from supervisors, coworkers or family who saw the change firsthand.
Why Josh takes these cases
When Josh was a teenager, his father was permanently injured in a bicycle accident. For nearly twenty years, the family's income came from a long-term disability policy his father's employer had purchased about a year before it happened.
He has said that the reason he does this work is that he knows what that policy meant, and what it would have meant if the carrier had decided differently.
When Should You Call a Long-Term Disability Lawyer?
Call before the appeal, not after. That is the honest answer, and it is the one most people wish they had heard earlier. A few situations where it matters most:
Your claim was denied outright. The appeal is the record. Once it closes, adding to it is usually not possible.
Benefits were paid and then stopped. Terminations often coincide with a change in the definition of disability or with a policy limitation rather than with a change in your health.
The insurer keeps requesting more information. Repeated document requests can be diligence. They can also run the clock and build a record of noncompliance.
You have been asked to attend an examination arranged by the insurer. These examinations become evidence. What happens in them matters.
You are still on benefits and the two year mark is coming. Calling now is worth far more than calling later, because the file can still be built rather than rebuilt.
What Does It Cost to Hire a Disability Attorney?
Nothing upfront. We handle long-term disability matters on a contingency basis, meaning no fee unless we recover benefits, and the initial review is free regardless of whether we take the case.
You will also deal with the attorney handling your claim rather than being passed down a chain. Direct attorney access is something we keep saying because it is the actual product of a small team.
Long-Term Disability Questions California Clients Ask
Can an insurance company use artificial intelligence to deny my disability claim?
There is no California law that stops a disability income insurer from using automated tools in a benefit decision. California's 2024 law on artificial intelligence in utilization review, often called the Physicians Make Decisions Act, applies to health insurers and health plans, not to disability income coverage. The California Department of Insurance guidance on that law is limited to health insurance operations. For an employer plan, the protection comes instead from the federal claims procedure rule, which requires a meaningful review by an appropriate named fiduciary and an explanation you can actually respond to.
Do I have to sue in federal court?
Not necessarily, though that is where these cases almost always end up. Federal law gives state and federal courts concurrent jurisdiction over claims to recover plan benefits, but insurers routinely remove a case filed in state court to federal court. The practical result is a federal bench trial on a written record, without a jury.
Can other income reduce my long-term disability benefit?
Often yes. Many group policies contain offset provisions that reduce the monthly benefit by other income the policy lists, such as California State Disability Insurance, pension or retirement payments, or earnings from other work. The list and the math differ from policy to policy, and carriers sometimes apply offsets more broadly than the policy allows. Read the offset section of your policy, or send it to us and we will read it with you.
Can the insurance company put me under surveillance or check my social media?
Yes, and it happens more than most claimants expect, particularly around the twenty-four month review and after an appeal is filed. Investigators film public activity, and a few minutes of footage can be presented out of context against months of records. Nothing about that is a reason to stay home. It is a reason to know it is possible and to keep what you post consistent with what you have reported.
Can I still work part time and receive benefits?
Often yes, depending on how your policy defines disability and how it treats residual or partial benefits. Some policies pay a reduced benefit while you work at limited capacity, and some treat any work as evidence against the claim. Check the policy before changing your work status, because that decision is difficult to undo once the carrier has it in the file.
What if my employer, not the insurance company, is the problem?
Employment questions that surface inside a disability claim, such as leave, accommodation or termination, fall outside what we handle, and we refer those out. We stay on the insurer side of the problem, which is where the benefits live.
Your Policy Already Promised This
Somebody made a decision years ago to carry this coverage, whether that was you or an employer on your behalf. Premiums were paid the entire time you were healthy. The only thing that changed is that you finally needed it.
A denial letter is a position, not a verdict. It is written to sound final because claims that sound final get abandoned.
Send us the denial and the policy. We will tell you what deadline is running, what the appeal would need to contain, and whether we think it can be won. That conversation is free, and there is no fee unless we recover benefits.
Call Bonnici Law Group at 619-259-5199. Our office is at 1620 5th Avenue, Suite 625, San Diego, CA 92101.