Insurance Bad Faith Lawsuits

ERISA Law Group disability lawyers can represent you in filing a lawsuit against your insurance company for what is known as "bad faith" conduct.

Certain disability insurance claims may not be governed by the ERISA law. This is likely if one of the following applies:

  • You purchased an individual disability policy directly from an insurance agent.
  • Your employer is a branch of government - either local, state or federal.
  • Your employer is a church.

When ERISA law does not apply, you may be able to file a lawsuit against your disability insurer alleging that their claim denial involved "bad faith" conduct (some states do not permit "bad faith" lawsuits).

Insurance companies have a legal obligation to act fairly and in good faith when evaluating claims from their policyholders. When a company violates that duty by engaging in unfair claim handling practices, they can be held liable for the amount of the claim as well as punitive damages and other damages. The insurance company must also fight the case under legal rules that are much less favorable than the ERISA law.

The following actions have been deemed to be "bad faith" insurance claim practices in states that recognize such claims:

  1. Misrepresenting relevant facts of insurance policy provisions relating to coverage at issue.
  2. Failing to acknowledge and act reasonably and promptly upon communications with respect to claims arising out of insurance policies.
  3. Failing to adopt and implement reasonable standards for the prompt investigation of claims arising under insurance policies.
  4. Refusing to pay claims without conducting a reasonable investigation based upon all available information.
  5. Failing to confirm or deny coverage of claims within a reasonable time after proof of loss statement has been completed.
  6. Not attempting in good faith to effectuate fair and equitable settlements of claims in which liability has become reasonably clear.
  7. Compelling insured's to institute litigation to recover amounts due under an insurance policy by offering substantially less than the amount ultimately recovered in actions brought by such insured's.
  8. Attempting to settle a claim for less than the amount to which a reasonable man would have believed he was entitled by reference to written or printed advertising material accompanying or made part of an application.
  9. Attempting to settle claims on the basis of an application which was altered without notice to, or knowledge or consent of the insured.
  10. Making claims payments to insured or beneficiaries not accompanied by a statement setting forth the coverage under which the payments are being made.
  11. Making known to insured's or claimants a policy of appealing from arbitration awards in favor of insured's or claimants for the purpose of compelling them to accept settlements or compromises less than the amount awarded in arbitration.
  12. Delaying the investigation or payment of claims by requiring an insured, claimant, or the physician of either to submit a preliminary claim report and then requiring the subsequent submission of formal proof of loss forms, both of which submissions contain substantially the same information.
  13. Failing to promptly settle claims where liability has become reasonably clear under one portion of the insurance policy coverage in order to influence settlements under other portions of the insurance policy coverage.
  14. Failing to promptly provide a reasonable explanation of the basis in the insurance policy in relation to the facts or applicable law for denial of a claim or for the offer of a compromise settlement.
  15. Intentionally withholding or misinterpreting information, file documents, or policy provisions to hide facts that would favor the claimant.
  16. Requesting excessive documentation not required by the policy.
  17. Using illegal, fraudulent, intrusive, or demeaning investigative methods or procedures which victimize the insured.
  18. Advising claimant not to hire an attorney.

The ERISA Law Group disability attorneys have successfully prosecuted bad faith insurance cases. If you think you are a victim of bad faith conduct, you should not hesitate to contact us about your case.