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An insurance company will often deny a claim for total disability on the ground that is based solely on the claimant’s “self-reports.”  The insurance company is especially likely to assert this “self-report” defense where the claimant suffers from a condition like chronic fatigue syndrome or fibromyalgia that rarely, if ever, produces any “objective findings” on […]

If you have suffered personal injuries due to the negligence of another party, such as in an auto accident or in some other circumstance, and you have medical insurance that has paid some or all of your resulting medical expenses on your behalf, the wrong doer cannot claim that such medical insurance payments should reduce […]

Many insurance companies insist that a person suffering from fibromyalgia must provide “objective evidence” of disability in order to qualify for disability benefits.  A number of federal decisions, however, make very clear that a person seeking disability benefits for fibromyalgia need not establish “objective evidence” of disability. In Hawkins v. First Union Corp. Long-Term Disability Plan, […]

When an insurance company denies a claim, it will purport to state the reasons on which it bases its denial.  The insurance company’s reasons are all too often no more than a pretext for denying a claim it knows it should pay.  If the case proceeds to litigation, the insurance company will then assert any […]

When an insurance company or ERISA plan denies your disability claim, it often leaves you with more questions than answers.  You will likely receive a letter littered with conclusions as to why you are not disabled without any reasoned explanation as to why you do not qualify.  The law is clear, however, that an ERISA […]

Under California law, a private citizen can bring a lawsuit specifically intended to address the ills or injustices in society.  Recognizing that such lawsuits are highly risky and may be prohibitively expensive, in 1977, California passed a law often referred to as the Private Attorney General’s Act (“PAGA”).  Under PAGA, found at California Code of […]

When an insurance company denies a claim, it will often summarize in its denial letter the evidence cited by the insured in support of the claim.  The insurance company will do so in order to attempt to create an appearance that it actually reviewed and considered in good faith the evidence contrary to its decision.  […]

California case law is clear that an insured’s attempt to return work may not bar a finding of disability.  The California courts have long recognized that people who are struggling with pain and other symptoms will nevertheless attempt to work.  In recognizing that people may continue perform job duties that endanger their health, courts have […]

Some disability insurance policies include a provision that the insurer will try to use to disregard the insured’s actual job duties in deciding whether the insured is disabled.  A number of these policies, especially those sold by Standard Insurance Company, contain language that states that, in deciding whether to pay the claim, the insurer can […]

In the recent case of Backman v. Unum Life Ins. Co. of Am., 2016 U.S. Dist. LEXIS 74918 (N.D. Cal. June 8, 2016), in which the claimant sought disability benefits for a painful back injury, the US District Court for the Northern District reversed Unum’s denial and ordered the payment of benefits. Unum had denied benefits based on the opinions […]