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California Insurance Regulations Mean Lawsuits Can Be Filed, Depending on the Circumstances

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Anaheim, CAHaving a California insurance claim denied can be frustrating enough, but for people who do not understand how insurance rules and regulations work, a denied disability claim can be just the start of the frustrations. That is because there are various rules and regulations that govern when a person can file a denied disability insurance lawsuit and when an appeal must be filed, first. Not understanding the situation can be the difference between getting some money back and being left high and dry.

People generally come about their insurance coverage in one of two ways. Either they purchase the insurance themselves (known as first-party insurance), through an insurance broker or agent, or they have insurance through their employer. If the insurance is provided by an employer, then the insurance itself is covered by the Employee Retirement Income Security Act (ERISA). This is an important distinction, because claims covered by ERISA that are denied must first be appealed with the insurance company before a lawsuit is filed. Failure to appeal the denial can result in the lawsuit being thrown out of court.

Furthermore, that appeal must be filed within 180 days of the denial. Failure to appeal in a timely manner means that neither the appeal or the lawsuit can be filed. If the appeal is denied by the insurance company, then a lawsuit can be filed.

But even if a lawsuit is filed, the courts view ERISA-covered insurance differently than first-party insurance. For one thing, even in a lawsuit regarding ERISA-covered insurance, the judge will only examine the submitted paperwork and the patient’s file. There is no opportunity for the patient to testify. This means that all paperwork must be in order and clearly lay out the patient’s case. Second, even if the insured prevails, he or she will only be eligible to recover money that should have been paid out by the insurance claim, plus attorney’s fees. ERISA-covered insurance lawsuits are not eligible for punitive damages or pain and suffering claims.

These rules and regulations do not mean insurance lawsuits are impossible to file. In ERISA-covered insurance, a lawsuit can still be filed, the plaintiffs just have to file an appeal first. In first-party insurance, the lawsuit can be filed immediately upon a claim being denied.

Or, in the case of the CalPERS lawsuit, a lawsuit can be filed when plaintiffs learn about alleged mismanagement or misleading marketing regarding an insurance plan. In the case of the CalPERS lawsuit, plaintiffs Elma Sanchez and Holly Wedding alleged policyholders were not warned that premiums were grossly underpriced or that in 2009, CalPERS had stopped enrolling people in its program.

READ ABOUT CALIFORNIA DENIED DISABILITY INSURANCE LAWSUITS

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READER COMMENTS

Posted by

on
I am on SSDI and they have on 4 accassions stopped mybenefits. I have child support arrears and w court order to pay 2 different counties $50.00 each for a total of $100.00 a month in arrears. This court orders where made a decade prior to me recieving my SSDI. Ssdi is an insurance we.pay through the fica withholdings on our payroll checks.
Now on every instants that my SSDI was dicontinued Igot my benefits reinstated. Each time it took me about 1 year to clesr up SSAs mistake. When they reinstated my benefits they paid my back pay for the months I was discontinued. However they withheld 50 percent of my back pay total to pay on arrrears citing it was do to a court order. I only have the 2 court orders of 50 per month but they with help $850.00 per month on my back pay. SSA keeps cancelling my benefits and with hold my funds in this manner. It is illegal and they know it. I had to wait for to years for a responce on an administrative law judges appeal which wss denied. They keep saying the information is at the pay center somewhere in baltimore but I can never get to speak with anyone at the pay center. Ive asked for an audit denied. I am about to sue. SOCIAL SECURITY has avrule that forbids them to circumvent a court order and thats exactly what they do. There is nobody tobhold accountable and nobody will help you. This should be a class action and I need an attorny to file a federal claim against Social security to recover close to40,000.00 Iin illegal practices can anybody help me???

Posted by

on
I am on SSDI and they have on 4 accassions stopped mybenefits. I have child support arrears and w court order to pay 2 different counties $50.00 each for a total of $100.00 a month in arrears. This court orders where made a decade prior to me recieving my SSDI. Ssdi is an insurance we.pay through the fica withholdings on our payroll checks.
Now on every instants that my SSDI was dicontinued Igot my benefits reinstated. Each time it took me about 1 year to clesr up SSAs mistake. When they reinstated my benefits they paid my back pay for the months I was discontinued. However they withheld 50 percent of my back pay total to pay on arrrears citing it was do to a court order. I only have the 2 court orders of 50 per month but they with help $850.00 per month on my back pay. SSA keeps cancelling my benefits and with hold my funds in this manner. It is illegal and they know it. I had to wait for to years for a responce on an administrative law judges appeal which wss denied. They keep saying the information is at the pay center somewhere in baltimore but I can never get to speak with anyone at the pay center. Ive asked for an audit denied. I am about to sue. SOCIAL SECURITY has avrule that forbids them to circumvent a court order and thats exactly what they do. There is nobody tobhold accountable and nobody will help you. This should be a class action and I need an attorny to file a federal claim against Social security to recover close to40,000.00 Iin illegal practices can anybody help me???

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