The final option in any claim dispute is litigation. Our litigation team evaluates every available cause of action and prepares a detailed litigation plan. Time is often of the essence when deciding to file suit. There are financial concerns as well as certain time limitations that may apply.
All causes of action contain a statute of limitations, the time period in which a lawsuit must be filed. It is important to note that most contracts contain a separate “contractual time limitation period”. The “contractual limitation” is outlined in the disability insurance policy, and is the disability insurance company’s attempt to shorten the time period in which a lawsuit can be filed. The enforceability of a contractual limitation varies depending on state law; however, it is imperative that your lawsuit is filed timely.
The most common cause of action is for breach of contract. However, depending on the facts of your case, there may be additional causes of action that apply. These include, but are not limited to, insurance bad faith, intentional infliction of emotional distress, consumer fraud, and petitions for declaratory judgment. Depending on jurisdictional issues, the complaint/petition is filed in either state or federal court.
Causes of Action
Breach of Contract
The most common cause of action in a claim denial and/or termination is for breach of contract. This is because the disability insurance company’s position to deny liability must be based on the insured not satisfying the contractual provisions under their policy of insurance. Again, the disability insurance company is bound by the terms, conditions, and limitations of each policy.
In order to prevail under a breach of contract action, we must:
- Establish the existence of an insurance policy which provided coverage to the insured,
- Establish that the insured provided all reasonable documentation to establish their entitlement to a benefit under the policy,
- Establish that the disability insurance company failed to reasonably accept liability under the terms, conditions, and limitations of the contract/breached the contract, and
- That the insured suffered damages as a result of the breach.
We are able to accomplish this by:
- Confirming our clients occupation at the time of disability,
- Confirming our client suffered from a medical condition,
- Confirming our client received the level of medical care for their medical condition, dictated by their policy of insurance,
- Confirming the medical condition impaired the insured from performing the material and substantial duties of their occupation, to the point that an economic loss was sustained or the important duties could not be performed,
- Confirming all reasonable proof of claim documentation necessary for the disability insurance company to evaluate the claim was provided, and
- Highlighting any unreasonable and/or deficient conduct on the part of the disability insurance company during its administration of the claim.
Petition for Declaratory Judgment
A Petition for Declaratory Judgment is an important tool in litigation. It allows a claimant to seek the court’s guidance when questions exist regarding legal obligations or rights under their disability insurance contract. This typically occurs when a party seeks to obtain a ruling on the rights of the parties or issue of law stemming from the disability insurance policy. Declaratory Judgment actions can be plead independently or in conjunction with a breach of contract action, allowing a claimant to resolve confusion within the policy while moving to have the liability imposed upon the disability insurance provider.