Washington Disability Insurance Attorney

Representing Disabled Individuals Throughout Washington State

Disability insurance companies hope that you will never need to use your coverage. These companies often use confusing and ambiguous wording in their contracts to make it easier to dispute or deny claims—and harder for you to recover benefits.

At Dabdoub Law Firm, we are dedicated to standing up for the rights of disabled individuals from across all occupations and industries. For more than 20 years, we have devoted 100% of our practice to disability insurance law, representing clients in Washington State and nationwide. No matter the medical condition you have or the complexity of your case, our Washington disability attorneys are here to answer your questions, address your concerns, and fight for you.

Get started with a complimentary consultation today. Call (800) 969-0488 or fill out and submit our simple online contact form.

Why Was My Claim Denied?

Long-term disability benefits denial under the Employee Retirement Income Security Act (ERISA) can occur for various reasons. Here are some common reasons:

Insufficient Medical Evidence: One of the primary reasons for denial is a lack of sufficient medical evidence supporting the claimant's disability. Insurance companies may argue that the medical documentation provided does not adequately demonstrate the severity or permanence of the disability.
Failure to Meet Definition of Disability: ERISA plans typically have specific definitions of what qualifies as a disability. If the claimant's condition does not meet the criteria outlined in the plan document, the claim may be denied.
Pre-existing Conditions: Some policies have exclusions for pre-existing conditions, meaning that disabilities stemming from conditions that existed before the coverage began may not be covered. Insurance companies may deny claims based on this exclusion if they determine that the disability is related to a pre-existing condition.
Failure to Follow Treatment Plans: If a claimant fails to follow prescribed medical treatments or therapies without a valid reason, the insurance company may deny the claim on the grounds that the claimant has not taken reasonable steps to mitigate their disability.
Misrepresentation or Fraud: If the insurance company discovers evidence of misrepresentation or fraud in the claimant's application or during the claims process, they may deny the claim.
Occupational or Job-Related Disputes: Sometimes, disputes arise over whether the claimant's disability prevents them from performing their specific job duties. Insurance companies may deny claims if they believe the claimant is capable of performing alternative work within their skill set or if they argue that the claimant's occupation is not covered under the policy.
Failure to Meet Deadlines or Requirements: ERISA imposes strict deadlines and procedural requirements for filing claims and appeals. If claimants fail to adhere to these deadlines or provide requested information within the specified timeframe, their claims may be denied.
Independent Medical Examinations (IME): Insurance companies may request an independent medical examination to assess the claimant's condition. If the IME contradicts the claimant's medical records or suggests that the disability is not as severe as claimed, the insurance company may use this as grounds for denial.
Administrative Errors: In some cases, denials may occur due to administrative errors or misunderstandings. This could include lost paperwork, miscommunication between parties, or processing mistakes by the insurance company.

When facing a denial of long-term disability benefits, it's crucial for claimants to carefully review the denial letter, understand the reasons for denial, and consider appealing the decision with the help of legal counsel familiar with ERISA regulations.

What to Do If Your Disability Claim Is Denied

If your claim is denied, you have the right to request an appeal. If your case falls under the Employee Retirement Income Security Act (ERISA), as most do, you must request an appeal within 180 days of receiving notice that your claim was denied. If you fail to meet this deadline, you will not be able to appeal the claim denial, and you will lose out on your disability benefits.

You should also note that the appeal may very well be your last chance to submit evidence of your disability. As such, it is important that you take the time to properly prepare your case. We recommend that you work with an experienced and knowledgeable attorney who can guide you through this process and represent your best interests.

What If the Appeal Is Denied?

If your appeal is denied, the next step is filing a lawsuit against the insurance company in federal court (if your case falls under ERISA). With ERISA cases, you must typically follow the insurance company’s internal appeals process before filing a lawsuit.

Because the state of Washington has banned “discretionary clauses” in disability insurance policies, claimants who take their cases to court are on more equal footing with insurance providers than those in states that permit these clauses. When discretionary clauses are permitted, insurance companies have authority to decide what is—and isn’t—a disability, and courts generally defer to insurance companies when ruling on appeals.

In Washington, this is not necessarily the case. In fact, the state’s 2009 ban on discretionary clauses applies to all claim denials and benefits terminations occurring after 2009. This means that if your policy began prior to 2009 but you did not have your claim denied or your benefits terminated until 2010 or later, the ban applies.

It is of the utmost importance that you work with a skilled legal team that has the experience, resources, and skill to effectively navigate the appeals and/or litigation process on your behalf. At Dabdoub Law Firm, we have earned a reputation for providing personalized legal strategies and securing the results our clients need.

Why Choose Dabdoub Law Firm?

If your disability insurance case is governed by ERISA, you do not need to hire an attorney located in Washington State, as there are no state-specific laws that will affect your claim or your appeal (aside from the ban on discretionary clauses discussed above). Rather, it is more important that you have a lawyer who knows and understands ERISA-related issues, as well as all aspects of long-term disability claims.

At Dabdoub Law Firm, we believe that our team is set apart from the rest for the following reasons:

We focus exclusively on disability insurance law
We have worked with every major disability insurance provider
Our attorneys have been recognized for their legal capabilities
Our team works tirelessly to ensure every client receives the attention and support they need
We provide free consultations and do not collect attorneys’ fees unless we win

Our award-winning Washington disability lawyers are prepared to put their extensive experience and knowledge of complex disability laws, procedures, policies, and processes on your side. Wherever you are in the process, we are ready to help. We know that you are already navigating a difficult time in your life, which is why we are committed to helping you meet—and overcome—the challenges ahead.

Please do not hesitate to contact Dabdoub Law Firm today for a complimentary case evaluation; call (800) 969-0488 to get started.