Disability Insurance Disputes

When a disability prevents you from working, disability insurance should provide the financial support you need to cover your expenses and maintain your quality of life. Unfortunately, it’s not always this easy. Many disability claims are denied, leaving policyholders feeling frustrated, overwhelmed, and uncertain about what to do next.

Whether you have a private policy, an employer-sponsored plan, or an ERISA-regulated disability policy, insurance companies can delay or deny claims without thinking there’s a real person on the other side of the paperwork. They may leverage vague policy exclusions or bad faith tactics to protect themselves and reduce your rightful compensation. It can be difficult to advocate for yourself alone, but with an attorney, you have a much stronger chance of reaching the best possible outcome.

At The Nation Law Firm, we’re committed to helping our neighbors fight back against unfair insurance practices. Our team has the experience, resources, and compassion to help you navigate the claims process, appeal denials, and take legal action when necessary – and we’re right around the corner.

Complete our free case evaluation to get started.

Types of Disability Insurance Policies

Disability insurance offers a financial buffer when medical conditions prevent you from returning to work. Not all policies provide the exact same coverage, though, so it’s important that you’re familiar with them to navigate the process effectively.

Short-Term Disability Insurance: Provides benefits for typically three to six months, covering temporary disabilities caused by injury, illness, or recovery from surgery.
Long-Term Disability Insurance: Covers extended disabilities lasting months or years, often paying a percentage of lost wages until you can return to work or reach retirement age.
Employer-Sponsored Disability Insurance: Offered through your workplace as part of an employee benefits package, these policies are often governed by ERISA (Employee Retirement Income Security Act). ERISA regulations create strict deadlines for claims and appeals, which can make it harder to sue the insurer if your benefits are denied.
Private Disability Insurance: Purchased individually outside of work, these policies offer more flexibility and higher benefit payouts, but insurance companies closely scrutinize claims and may require extensive medical evidence before approving benefits. They also operate separately from your employment, making communication between you and your employer uniquely important.

No matter what type of policy you have, there’s always a chance your insurance provider attempts to delay or deny your claim. If you suspect bad faith is at play, contact a legal expert sooner rather than later.

Common Reasons for Disability Claim Denials

Insurance companies will deny claims for a variety of reasons, leaving you without the financial support they need when they need it most. While every case is unique, most denials fall into a few common categories:

Pre-Existing Conditions: Insurers may argue that your disability existed before your policy took effect to disqualify you from seeking damages.
Insufficient Medical Documentation: Claims require strong medical evidence, including doctor’s reports, diagnostic tests, and treatment records. Missing, inconsistent, and incomplete documentation can lead to denials.
Failure to Meet Policy Definitions: Policies define what qualifies as a disability. Insurers may claim that your condition does not meet their specific criteria, even when it clearly prevents you from working.
Procedural Errors or Missed Deadlines: Disability insurance claims have strict deadlines and paperwork requirements. Filing too close or past deadlines can disqualify your claim.
Bad Faith Insurance Tactics: Some insurers use delays, excessive paperwork requests, or misinterpretations of policy terms to avoid paying valid claims.

A denial does not mean the end of your claim – You have the right to appeal and fight back. If your claim was denied, our team can support you through the claims process and help you reach the best possible outcome.

How to Appeal a Denied Disability Claim: 5 Steps

If your disability claim has been denied, you have the right to file an appeal and challenge their decision. This step is very important, though, requiring strong evidence and careful attention to deadlines.

Review the Denial Letter: Your insurer must provide a written explanation for the denial. Identify that reason, whether it’s a lack of medical evidence, policy exclusions, or a missed deadline, to start planning your next steps.
Understand Your Appeal Deadline: Employer-sponsored ERISA disability claims have strict deadlines, often requiring an appeal within 180 days. Private disability insurance appeals may have different timeframes – make sure you find them quickly.
Gather Supporting Medical Evidence: Work with your doctor to provide updated medical records, specialist evaluations, and functional capacity assessments demonstrating how your condition prevents you from working. This additional evidence will confirm your condition beyond initial documentation.
Write a Strong Appeal Letter: Clearly explain why your claim should be approved in a written document, addressing the insurer’s reasons for denial and including supporting evidence. You should review this document alongside legal support before sending it.
Consider Legal Assistance: Insurance companies have teams of lawyers reviewing claims. Having an attorney on your side can level the playing field and ensure your appeal is as strong as possible.

If you’re facing an appeal, The Nation Law Firm can help you build your case, meet all deadlines, and challenge unfair insurance tactics.

Bad Faith Insurance Practices in Disability Claims

Insurance companies are required to handle disability claims fairly and in “good faith,” but many use delay tactics, unfair denials, and misleading policy interpretations to avoid paying legitimate claims. This behavior, called “bad faith,” can quickly turn your claim upside down with lowball offers, delays, or denials.

Some common bad faith tactics include:

Unreasonable Delays: Insurers may take months to process claims, request unnecessary paperwork, or repeatedly ask for the same information to delay your payout.
Misinterpreting Policy Terms: Some insurers wrongfully claim that your condition doesn’t meet the policy’s definition of disability, even when medical evidence proves otherwise.
Lowball Settlements: Even when a claim is approved, insurers may offer much lower benefits than what the policyholder is entitled to receive.
Ignoring Medical Evidence: Denying claims by cherry-picking certain records while ignoring key medical reports that support disability.
Wrongfully Claiming a Pre-Existing Condition: Some insurers misuse pre-existing condition clauses to deny benefits, even when the disability developed after the policy started.

Insurance companies employ bad faith tactics, hoping you’ll cave out of desperation or exhaustion. Their attempt to take advantage of you can quickly be stopped with the help of an experienced attorney from The Nation Law Firm.

ERISA Claims Process

If you have disability insurance through your employer, your claim is likely governed by ERISA (Employee Retirement Income Security Act) – a federal law that sets strict rules for disability claims and appeals.

ERISA claims follow a structured process. Here’s what to expect:

Steps in the ERISA Claims Process

Filing Your Initial Claim: You must submit your disability claim with medical documentation, employment records, and any supporting evidence. The insurance company has 45 days to approve or deny the claim, with the option to extend by another 30 days under certain conditions.
Receiving a Denial and Reviewing the Explanation: If your claim is denied, the insurer must provide a detailed explanation, citing specific policy provisions and evidence.
Submitting an Appeal: Under ERISA, you typically have 180 days to appeal a denial. This is your only opportunity to submit new evidence, such as additional medical records or expert opinions, and challenge their decision.
Final Decision by the Insurance Company: The insurer must respond to the appeal within 45 days, though they can request an additional 45-day extension in certain cases.
Filing a Federal Lawsuit: If the appeal is denied, your only option is to file a lawsuit in federal court. ERISA limits your ability to present new evidence, meaning the court will likely rely only on what was included in the initial claim and appeal.

ERISA is, unfortunately, designed to protect insurers, not policyholders. Victims face strict deadlines, limited opportunities to submit evidence, and a high legal burden when challenging a denial in court. Missing an appeal deadline or failing to include key evidence can severely impact your case.

If your ERISA disability claim has been denied, legal representation is essential to ensure your appeal stays on track. At The Nation Law Firm, we can help guide you through this complex process, protect your rightful compensation, and ensure your rights are upheld from beginning to end.

Medical Evidence and Documentation

Strong medical evidence is the foundation of a successful disability insurance claim. It showcases your injuries and proves your argument definitively, making it crucial to provide detailed and consistent documentation.

Some key evidence you should focus on include:

Doctor’s Reports: A clear statement from your treating physician explaining how your condition limits your ability to work and why you meet the policy’s definition of disability.
Specialist Evaluations: Reports from neurologists, orthopedic specialists, psychologists, or other relevant experts are highly persuasive in proving long-term disabilities.
Functional Capacity Evaluations (FCEs): Tests that measure your ability to perform physical tasks such as standing, lifting, or sitting for extended periods.
Diagnostic Tests and Medical Imaging: MRI scans, X-rays, blood tests, and other objective test results help validate your condition.
Consistent Treatment Records: A documented history of ongoing treatment, prescribed medications, therapy, and follow-up visits shows the persistence and severity of your condition.

Sometimes, the severity of a disability isn’t immediately apparent to a third party. All of this evidence will allow someone else to step inside your condition and fully understand it, leaving no room for them to diminish or deny the compensation you deserve.

Psychological and Mental Health Disability Claims

Living with a mental health condition can be just as disabling as a physical illness, yet insurance companies often dismiss or undervalue these claims. They may deny that you’re suffering entirely or attempt to diminish your claim due to a lack of “objective” evidence, even though mental health conditions are not always measurable through traditional medical tests.

You’ll need strong evidence to reach a successful outcome, including:

A diagnosis and treatment plan from a licensed mental health professional that explains how your condition impacts your daily life and ability to work.
Therapy and medication records, showing consistent treatment efforts.
Personal statements from you, family members, or colleagues describing how your condition affects your ability to function.
Neuropsychological testing or other assessments that demonstrate cognitive or emotional impairments.

If you’re struggling with anxiety, depression, PTSD, or another mental health disorder, the last thing you need is an insurer questioning whether your condition is “severe enough” to qualify for benefits. At The Nation Law Firm, we have over two decades of experience advocating for the fullest extent of our client’s mental health claims – and a proven track record of success.

Challenging “Difficult-to-Prove” Diagnoses

Living with a chronic illness that doesn’t show up on standard tests can be exhausting, not just physically but emotionally. When your symptoms make it impossible to work, it’s important that your insurance provider honor your insurance agreement and provide the compensation you need to get back on your feet.

If you’re facing a denial, we’re here to help. There are ways to validate your claim, including:

Specialist reports that document the severity of your symptoms.
Daily symptom logs that show how your condition impacts your ability to function.
Functional assessments that measure how chronic pain, fatigue, or cognitive issues limit your abilities.

Insurance companies shouldn’t get to decide whether your suffering is “real enough” for benefits. The Nation Law Firm is here to stand with you, fight for your rights, and ensure you get the benefits you need.

What to Do If Your Appeal Is Denied

A denied appeal doesn’t mean the fight is over. There are legal paths that can challenge their denial, hold them accountable, and bring you the compensation you’re entitled to.

Here’s what you can do next:

Request the final denial letter to understand why your appeal was rejected.
Talk to an attorney who understands disability law. Having legal support can make all the difference.
Consider legal action – ERISA claims may require filing in federal court, while private policies allow direct lawsuits against insurers.
Strengthen your case with additional medical reports or expert opinions.

You’ve been fighting for your health. You shouldn’t have to fight your insurance company, too. The Nation Law Firm can handle this process for you – so you can focus on your recovery.

Punitive Damages and Bad Faith Lawsuits

Filing a disability claim is supposed to provide financial relief when you need it most. When an insurance company deliberately denies, delays, or underpays your claim in bad faith, you may not only be entitled to punitive damages for their misconduct, along with your policy benefits.

When can you sue for bad faith and punitive damages?

Insurance companies are legally required to handle claims fairly, but some engage in unethical practices to avoid paying valid benefits. If your insurer has:

Wrongfully denied your claim without a proper investigation
Ignored or misrepresented key medical evidence
Unreasonably delayed payments or forced excessive appeals
Used deceptive policy interpretations to justify a denial

Then, you may have grounds to file a bad faith lawsuit. In Florida, policyholders can take legal action to hold an insurance provider accountable for their illegal behavior and recover the compensation they deserve.

If your insurer is acting in bad faith, The Nation Law Firm will fight to hold them accountable and help you recover every dollar you’re entitled to. We’re here to support you toward the best possible outcome, and it costs nothing upfront to team up with an experienced member of our team. Get started today with a free case evaluation.

Frequently Asked Questions

What should I do if my disability claim is denied by my insurance company?

A denial is not the end of your claim – You have the right to appeal. Review the denial letter carefully, gather additional medical evidence, and consult an attorney to build the strongest possible appeal.

How does the appeals process work for ERISA disability claims?

For ERISA-governed disability claims, you typically have 180 days to file an appeal seeking compensation for your disability. This is your only chance to submit additional evidence before a lawsuit, so it’s critical to provide thorough documentation and legal support.

What evidence do I need to support my disability insurance claim?

Strong claims include detailed medical records, doctor’s statements, diagnostic tests, treatment history, and functional capacity evaluations. The more clear, objective evidence you provide, the harder it is for insurers to deny your claim.

Can I still file a claim for mental or psychological conditions like anxiety or depression?

Yes, but mental health disability claims are often more difficult to prove. Consistent treatment records, psychiatrist evaluations, and neuropsychological testing can help strengthen your case.

What are the most common reasons insurance companies deny disability claims?

Insurers frequently deny claims due to insufficient medical evidence, pre-existing condition exclusions, missed deadlines, or by claiming you don’t meet the policy’s definition of disability. Many denials are unfair, and an appeal can correct these issues.

How can I prove a disability with a condition like fibromyalgia or chronic fatigue syndrome?

Conditions without clear diagnostic tests require detailed medical documentation, including specialist reports, symptom logs, and functional assessments. Insurers often challenge these claims, so having strong supporting evidence is non-negotiable.

What are my rights if my insurance company acts in bad faith?

If your insurer wrongly delays, denies, or undervalues your claim, you may have a case for a bad faith lawsuit. If you qualify, this could allow you to recover punitive damages along with your owed benefits.

How long does the ERISA appeals process typically take?

Insurance companies must respond to an ERISA appeal within 45 days, but they can request an extension of up to 90 days. If denied, your only remaining option is filing a federal lawsuit, and you should consult an attorney.

Can I sue my insurance company if they deny my disability claim?

Before you can pursue a lawsuit, you must file an appeal. If they wrongfully deny the appeal, that’s when you can start considering legal options.

For ERISA disability claims, lawsuits must be filed in federal court, and you can only use evidence submitted during the appeal. For private disability insurance policies, you can sue the insurer directly for wrongful denial.

What should I look for when hiring an attorney for a disability insurance dispute?

Look for an attorney specializing in disability insurance law, understands ERISA regulations, and has experience holding insurance companies accountable. The Nation Law Firm has helped countless clients fight back against unfair disability denials – and we’re right in the heart of Florida.