Helpful Tips to Policyholders: Pay Close Attention to Plan's Limitations Provisions

Posted in: Case Updates, Disability Insurance, ERISA, Insurance Questions and Concepts, Policy Interpretation, Statute of Limitations March 06, 2014

Do you have a disability insurance policy, health insurance policy or life insurance policy through your work?  If you do, you should read this article as you may miss some important deadlines if you do not.

The Supreme Court’s recent  holding that the limitations periods in employer-sponsored plans are enforceable, even where such limitations periods began to run before a cause of action accrued, had a rippling effect through federal courts, the insurance bar and participants alike.  Under the Employee Retirement Income Security Act of 1974 (“ERISA”), participants must exhaust the plans’ administrative process before bringing suit.  Previously, the Ninth Circuit and majority of circuit court of appeals had held that the statute of limitations for filing suit under ERISA commenced after an insured exhausted all administrative remedies.  However, the high court explained that a plan may impose a particular limitations period, which begins from the date proof of claim is due, rather than after the conclusion of the administrative process.  Heimeshoff v. Hartford Life & Accident Insurance Co. et. al., 134 S. Ct. 604 (2013).  Below, we examine the implications Heimeshoff has for insureds and provide helpful tips.

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How to Read Your ERISA Disability Denial Letter: A Gritty Exploration of the Common Language in Actual Denial Letters and How to Respond to Them

Posted in: Disability Insurance, ERISA, Insurance Questions and Concepts November 25, 2013

If your ERISA short-term disability or long-term disability claim was denied, you likely received a dry, lengthy rejection letter explaining the basis for the denial.  This letter may appear persuasive, but insurers/claims administrators often offer improper justifications to support their denial decisions to increase their profits.  Calling an experienced ERISA attorney should be your next move.  However, if you decide to handle the matter yourself, then you must critically examine each basis relied upon to deny your claim.  You should never blindly accept what the insurance company is telling you.  Below is language we frequently see in our review of ERISA insurance denial letters, and tips on how to view and respond to them.

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FAQs: What do you need to know about long-term care insurance?

Posted in: Insurance Questions and Concepts, Long Term Care Insurance August 29, 2013

The McKennon Law Group PC periodically publishes articles on its California Insurance Litigation Blog that deal with frequently asked questions in the insurance bad faith, life insurance, long term disability insurance, annuities, accidental death insurance, ERISA and other areas of the law.  This article in that series focuses on long-term care insurance.

What is long-term care insurance?

Long-term care insurance refers to coverage for health care and treatment in extended care facilities (for example, convalescent homes, nursing homes, etc.), at-home health care and/or adult day care for individuals (usually above the age of 65 or with a chronic or disabling condition that needs constant supervision) rather than in an acute care unit of a hospital.  See California Insurance Code § 10231.2 et seq.  Long-term care insurance is designed to pay for care that is generally not covered by health insurance, Medicare or Medicaid.

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FAQs: Should You Hire an Attorney to Help You With Your ERISA Appeal?

Posted in: Disability Insurance, ERISA, Insurance Questions and Concepts, Life Insurance July 22, 2013

The McKennon Law Group PC periodically publishes articles on its California Insurance Litigation Blog that deal with frequently asked questions in the insurance bad faith, life insurance, long term disability insurance, annuities, accidental death insurance and ERISA areas of the law.  This article in that series focuses on appealing a denial of your long term disability insurance claim for long term disability insurance benefits under ERISA.

The short answer is “Absolutely.”

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Ten Things to Know Before You File a Claim for Long-Term Disability Insurance Benefits

Posted in: Disability Insurance, ERISA, Insurance Questions and Concepts July 15, 2013

1.  Make Sure You Have a Complete Copy of Your Plan/Policy The first step when making a claim for long-term disability insurance benefits is to secure a copy of your policy.  If your employer provided your insurance coverage, request a full and complete copy of your policy from Human Resources.  Make sure you get a complete copy of the plan/policy, not just the Summary Plan Description.  If you purchased your policy directly from the insurance company, or through an insurance agent/broker, you probably already have a copy of your policy with the application attached.  If you cannot locate it, contact the agent/broker and/or the insurance company to request a copy of the policy.

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FAQs: Can an Insured Sue for Future Policy Benefits and Attorneys' Fees in a Lawsuit Against an Insurer for Disability Insurance Benefits?

Posted in: Disability Insurance, ERISA, Insurance Questions and Concepts April 18, 2013

The McKennon Law Group PC periodically publishes articles on its California Insurance Litigation Blog that deal with frequently asked questions in the insurance bad faith and ERISA area of the law.  This is another such article in that series.

If an insurance company has unfairly denied an insured’s disability benefits or has otherwise committed bad faith, an insured may be entitled to substantial compensation for harm that the insured has suffered.  In fact, not only may an insured seek payment of all the unpaid benefits, but the insured can also sue for future policy benefits, among other damages.

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FAQs: Who May Sue or Be Sued for Insurance Bad Faith?

Posted in: Insurance Bad Faith, Insurance Questions and Concepts May 15, 2012

The McKennon Law Group PC periodically publishes articles on its California Insurance Litigation Blog that deals with frequently asked questions in the insurance bad faith and ERISA area of the law.  This is another such article in that series.

Generally, in order to sue for insurance bad faith there necessarily must be an insurance policy at issue that establishes a concept known as “privity of contract” between an insured and an insurer.  This means that an insured under an insurance policy typically may sue for bad faith if the insured is entitled to benefits under a policy and if those benefits are wrongfully withheld or payment was wrongfully delayed.  This includes the contracting parties (persons named as insureds) as well as others entitled to benefits as “additional insureds” or as express beneficiaries under the policy.  In insurance parlance, this means that the “named insured” and any “additional insureds” may sue.  For example, an auto liability insurance policy covering a vehicle may extend coverage to permissive users as additional insureds.

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In an ERISA Case, What Actions Will Reduce the Level of Discretion Afforded the Claims Administrator/Insurer?

Posted in: ERISA, Insurance Questions and Concepts, Standard of Review January 24, 2012

This article continues our series of articles answering basic questions about insurance law and the Employee Retirement Income Security Act of 1974 (commonly referred to as “ERISA”).  This one addresses:  In a lawsuit governed by ERISA, what actions taken by the claims administrator (usually an insurance company such as Blue Cross/Blue Shield or CIGNA) will reduce the level of discretion the court gives the insurance company’s decision when reviewing the decision for an abuse of discretion?

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Avoiding the Potholes on the Road to Retirement: Understanding Annuity Risks

Posted in: Annuities, Insurance Questions and Concepts December 20, 2011

Saving for one’s own retirement is something everyone needs to consider.  There are many financial vehicles that can be used when traveling along the road to retirement.  One of these financial vehicles is an annuity.  However, annuities are often not suitable for consumers, especially more elderly consumers, because of excessive “hidden” fees and large surrender charges that apply when annuities are surrendered/terminated before a certain time.  This is due in part to large commissions paid to agents who sell them, who often act in their own best interest, rather than in the interest of consumers.  John Waggoner of USA Today provides some sound advice in his recent article entitled “Annuities are a Retirement Option, But Be Wary of Fees:”

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