Insurance claims denied or underpaid · insurance claim denial and bad faith

You paid the premiums. Now the insurer won't pay

The letter from the insurer arrived on a Friday. It thanked you for your patience, quoted a paragraph of the policy you had never read, and said the claim was denied. Or the disability benefits you had been living on simply stopped. Or nothing was denied, exactly: the offer covered a fraction of the repairs, or the insurer asked for the same documents a third time.

An insurance policy is a contract. When you have kept your side, the insurer is expected to keep its side and to handle your claim fairly. You shouldn't have to learn the appeal rules, or work out which lawyer handles this kind of claim, on your own. Tell us what happened, in your own words, and a lawyer at our firm will look at your case.

Tell us what happened

This may be for you if

My long-term disability benefits were denied or stopped.
My home or business insurer denied a claim for fire, water, storm or theft damage, or paid far less than it cost.
A life insurance company refused to pay after my family member died.
The insurer keeps delaying, asking for more documents, and not deciding.
I have been told I have to file an appeal, and I don't know how.

What we do, and what we do not

We do

A lawyer at our firm looks at your case, reads what the insurer has said, and tells you straight what we can do.
Insurance disputes turn on your policy and on the law that governs it. If we take your case and another firm is better placed to lead it day to day, we choose that firm for you, from firms we have vetted for their expertise and track record in insurance and disability claims, so you don't have to search or guess.

We do not

We don't promise that a denial will be reversed or say what a claim is worth. The insurer decides an appeal, and if it goes further, a court decides.

Two firms on your side, for the cost of one

When another firm leads your case, you have two law firms on your side, and it costs you no more than one firm would. The firm leading it day to day is one that represents policyholders in claims like yours, and it's your first call for questions about the case. Our firm stays responsible for your case with them for as long as it lasts: we check in often, keep our own calendar of its deadlines, and we're who you write to if something doesn't feel right.

You decide whether to go ahead, and nothing happens until you say yes.

How it works, step by step How fees work, and how they are shared

Problems we often hear about

Disability benefits denied or stopped
Long-term disability claims that were denied, cut off or reduced, and the appeal that comes before any court.
Home and business insurance claims
Fire, water, storm, theft and other property claims that were denied or underpaid.

What helps to have ready

Your complete policy, including every endorsement (the add-on pages that change what the policy covers). If the coverage is through work, the plan papers your employer gave you.
The denial letter or the latest letter about your claim, and a note of the day it reached you.
Your claim number and the name of the adjuster or claims handler.
Everything you have sent the insurer, and when you sent it.
Photos, estimates, invoices or medical records that support the claim.
Notes of phone calls with the insurer: the date, who you spoke to, and what they said.

Disability denial organizer
A printable page for the denial letter, your policy, medical records, letters with the insurer and a dated timeline.
Disability claim denied: what to gather first
The deadline, the claim file, the policy, your medical records and a dated timeline, gathered before the appeal is due.
What to have ready before you talk to a lawyer
A short, practical list you can use for any kind of problem.

Questions people ask

My insurance comes through my employer. Does that change anything?

Often, yes. Disability, life and health coverage provided through a job is usually governed by ERISA (the Employee Retirement Income Security Act), a federal law for the benefit plans employers provide. Under ERISA you usually must first use an administrative appeal, meaning a written request asking the insurer to look at its own decision again, before you can go to court. What goes into that appeal may be the main evidence a court later looks at, so it's worth getting help before you file it, not after.

What is the claim file, and should I ask for it?

The claim file is everything the insurer gathered, relied on or created while deciding your claim: medical reviews, reports from its own doctors, notes and the policy terms it used. For coverage through work, federal rules let you ask for a copy free of charge. Ask in writing, keep a copy of your request, and note the date. You can't answer the insurer's reasons well without seeing what it relied on.

What does it mean for an insurer to act in bad faith?

Bad faith is the legal name for an insurer failing to treat you fairly: denying a claim without a reasonable basis, refusing to investigate properly, or dragging out a clear claim. What the law lets you do about it differs a great deal from state to state, and coverage through an employer usually follows the federal rules instead.

What does it cost?

It costs nothing to ask. Lawyers who represent policyholders often work on a contingency fee, a share of any recovery, and in some cases the law lets you recover lawyer fees from the insurer.

Damage to your home
If someone else caused the damage to your home or property, there may be a claim against them as well.
How workers' compensation fits with your other claims
If your injury or illness came from work, workers' compensation may be involved too.
Treated unfairly at work
If you lost your job because of the illness or injury that stopped you working.

This page explains things in general terms. It is not legal advice about your situation, and the law differs from state to state.