Dealing with a disability is challenging enough without the added stress of navigating a complicated insurance claim. Unfortunately, many Californians discover that securing disability benefits—whether through an employer-provided policy or a private one—is rarely as straightforward as they expect. At Kantor & Kantor, we know better than anyone just how difficult insurance companies can make it for people to get the benefits they need. Whether you are dealing with a disability insurance policy provided by your employer or a private policy you purchased on your own, understanding the key differences between these types of claims is essential.
Contact our California insurance lawyers at 818-886-2525 and book your free consultation.
Differences Between ERISA and Private Disability Insurance Claims
Here are the key differences between ERISA and private disability insurance claims:
Governing Laws: Federal vs. State
ERISA disability claims are governed by federal law. This means that if your disability insurance is provided through your employer, it is most likely covered by ERISA. Under ERISA, you must take specific timely steps before you can litigate your denial of benefits, and your right to recover is limited to the benefits you are owed, plus attorneys’ fees and interest.
Even worse, under ERISA, you are required to file the internal appeal within the time frame specified in the denial letter, and a late appeal can completely prevent you from being able to dispute the denial in federal court.
Private insurance claims, on the other hand, are regulated by state law. In California, the state provides additional protections for policyholders, including consumer rights and more favorable rules for challenging a denial. This state-level oversight often allows more flexibility and options when it comes to appealing a decision.
Appeals Process: Critical Differences
In an ERISA claim, if your disability benefits are denied, you must go through an internal appeals process with the insurance company before you can file a lawsuit. This can be frustrating, because the same insurance company that denied your claim in the first place is responsible for reviewing your appeal.
Worse yet, when you get to court, the review is usually limited to the information submitted during your internal appeal. In other words, you will not get a second chance to provide new evidence.
Private disability insurance claims provide more flexibility in this regard. With a privately purchased policy, if your claim is denied, you generally have the right to file a lawsuit without going through an internal appeal.
This means that in court, you can present additional evidence to support your case. Plus, the court will typically review the case without deference to the insurance company’s prior decision.
Damages
Remedies under ERISA are typically limited. Claimants can usually recover only the benefits due under their plan, along with associated legal costs. ERISA does not allow for punitive damages or damages for pain and suffering.
Claimants under private insurance policies in California can seek broader remedies, including compensatory damages and, in some cases, punitive damages. This can provide a much greater deterrent against unfair practices by insurers.
How Our Insurance Attorneys Can Help You with Your Insurance Case
When you are facing an insurance dispute, it can feel like the odds are stacked against you. Insurance companies have teams of lawyers and endless resources at their disposal.
Our insurance attorneys in California will level the playing field and fight for the benefits you deserve. We understand the stress and frustration that comes with denied claims, delayed payments, and confusing policy language—and we are here to help.
Here is how our experienced insurance attorneys can support you through every step of your insurance case.
1. Comprehensive Case Evaluation
Every insurance case starts with a thorough evaluation. We listen to your story, review your insurance policy, and analyze all correspondence with your insurance provider to understand the full scope of your situation.
This comprehensive approach helps us identify the strengths and weaknesses of your case, allowing us to develop a tailored strategy that aims to achieve the best possible outcome for you.
2. Strategic Claim Submission and Appeal
Filing an insurance claim or appealing a denial can be fraught with procedural pitfalls. Our attorneys guide you through the entire process, ensuring that your claim is submitted correctly and on time.
We gather all necessary documentation and evidence, craft a compelling case on your behalf, and handle all communications with the insurance company. If your claim is denied, we are prepared to lead a strong appeal, utilizing our detailed knowledge of insurance law to challenge any unfair decisions.
3. Negotiating With the Insurance Company
Even when a claim is accepted, insurance companies often try to offer a lower payout than what you deserve. Our attorneys are skilled negotiators, and we know the tactics insurers use to minimize payouts.
We will work to negotiate a fair settlement on your behalf, ensuring you receive the full benefits outlined in your policy. If negotiations fail, we are prepared to escalate the case and take legal action if necessary.
4. Aggressive Advocacy in Litigation
If negotiations fail or if an appeal is denied, our legal team is ready to advocate for you in court. We are seasoned litigators with a track record of success in both federal and state courts. At trial, we are tenacious in our representation, arguing on your behalf and leveraging our legal expertise to seek a favorable verdict.
5. We Stand Up to Insurance Bad Faith
Sometimes, insurance companies engage in unlawful practices. This is known as “bad faith,” and it occurs when insurers unreasonably deny claims, delay payments, or fail to investigate claims properly.
If we find that your insurance company is acting in bad faith, we will take immediate action. In California, policyholders have the right to sue insurance companies for bad faith; if successful, you may be entitled to additional damages. Our attorneys will hold your insurance company accountable and make sure they play by the rules.
Contact Our Team for Legal Support You Can Count on
You need a team that empathizes with your situation and fights passionately for your rights. We are people helping people, and we look forward to helping you. We ensure they are treated fairly and with respect by their insurers, whether their plan falls under ERISA or through a private policy.
To request a free consultation, contact our insurance lawyers in California at 818-886-2525. Let us help you fight for your rights and get you the compensation you deserve.
