Short-term disability insurance programs provide an essential safety net to employees who are forced to miss time at work. In Los Angeles, all employees have taxes removed from their paychecks that are dedicated to funding the California disability insurance program. These benefit programs apply when an employee is unable to work for a minimum of eight days and provide income when a worker cannot return to their job.
However, as with all benefit programs, you must file a valid application to qualify for benefits. An application for disability insurance must include a properly formatted application and a doctor’s certification. Failure to provide any of these forms may result in your claim being denied.
A Los Angeles disability insurance claims denial lawyer can help you file an appeal if your claim is denied. This appeal may be able to provide much-needed income during a period of disability. Call a compassionate lawyer today to get started.
Appealing Your Health Insurance Claim Denial
Qualifying for Disability Benefits
California’s definition of a disability is expansive. It includes any illness or injury that prevents a person from working their normal job. Unlike workers’ compensation, the injury does not need to have occurred while at work. In fact, conditions such as pregnancy, childbirth, or even elective surgery may qualify.
It is a common misnomer that a physical injury is a prerequisite to qualify for disability benefits. On the contrary, a person with a mental health condition is just as eligible to receive benefits as one with a physical condition.
Why Disability Insurance Claims Are Denied
The State of California may deny a disability insurance claim for any number of reasons. One common reason is suspected fraud. If the state believes that an applicant misrepresented their condition on their application or did not seek out appropriate medical care to make a recovery, their claim may be denied.
Alternatively, if someone is working part-time, they may still file for benefits. However, the state may determine that the applicant’s part-time schedule is by choice, rather than due to their disability. If California rules that a person is self-limiting themselves to part-time work, they will not issue benefits. A Los Angeles disability insurance claims denial attorney can help people understand the reason their claim was denied and pursue an appropriate remedy.
Appealing a Denial of Disability Benefits
Whenever the State denies a disability insurance claim, they must state their reason for doing so. They are also required to provide a letter explaining how the rejected party can appeal their denial.
The first step is to file an appeal form to the Employment Development Department, or EDD. After receiving a correctly filed appeal form, the EDD will reexamine the case file and take the appellant’s argument into consideration.
If the EDD still denies the claim, the agency will automatically forward the appeal paperwork to the local Office of Appeals, which will assign the case for a hearing with an impartial judge. This judge then conducts a hearing where the applicant and the state have the right to plead their case.
Summary of a Case That We Filed
In addition to this example case summary, please view a full list of our results and client testimonials.
- We filed a case against New York Life Insurance Company for unreasonably denying our client’s claim for long-term disability benefits. Our client’s life was forever changed when he experienced a very traumatic event. This traumatic experience caused our client, a successful professional, to suffer from serious mental health issues, including post-traumatic stress disorder, depression, anxiety, and suicidal ideation. He has been unable to work due to his severe mental health struggles, but New York Life has unreasonably denied his claim for long term disability benefits, despite being contractually obligated to provide them. In addition, New York Life forced our client to undergo a biased Independent Medical Examination, which worsened his mental health issues and inflicted emotional distress on him. We are suing New York Life Insurance Company for, among other things, breach of the implied covenant of good faith and fair dealing, and breach of contract.
Los Angeles Disability Insurance Claims Denial Attorney Could Help
While California’s disability insurance program is designed to be user-friendly and easy to navigate, there are still specific rules that applicants must follow. If these rules are broken, even by mistake, a claim may be denied.
People with denied claims have the right to an appeal, and an experienced lawyer can help you file yours. By overseeing the appeal process and advocating on your behalf before a judge when necessary, Los Angeles disability insurance claims denial attorneys can help you obtain the benefits that you deserve. Schedule an initial consultation by contacting an attorney today.