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Insurance Disputes

Denying Your Claim Means More Money for the Insurance Companies

Insurance companies are only profitable if they take in more money in premiums than they pay out in claims.  Thus, it makes sense that a claims adjuster has an incentive to deny as many claims as possible.  Numerous investigations have proven that claims adjusters are often trained to find a reason to deny a claim as most policyholders do not know their rights and will accept the insurance company’s denial.

The following sections provide answers to commonly asked questions about dealing with insurance companies:

WylieLaw Stands Up to the Insurance Companies

WylieLaw specializes in own-occupation, private disability policy insurance claims, yet we handle cases involving insurance coverage claims of all kinds.  The experts at WylieLaw know how to read and interpret the small print of insurance policies and have a proven track record for making insurance companies pay their policyholders what they rightfully deserve. To read more about insurance cases won by WylieLaw, go to Decisions and Press.

Get Help Before It’s Too Late

In many cases, it is important to consult with an attorney before submitting a claim.  The attorneys at WylieLaw have specific and extensive experience in disability insurance and can offer sound legal advice on how to properly submit claim forms in order to avoid denial of benefits, often saving clients thousands of dollars and innumerable headaches caused by dealing with uncooperative insurance companies.  If you have a question about your rights as a policyholder or have a disability policy and are going to file a claim, contact WylieLaw.

Success Stories

  • After being approved and paying out disability benefits for a number of years, a claim was transferred from the insurance company (Equitable) to a third party administrator (Disability Management Services or DMS).  DMS requested the claimant submit to a Functional Capacity Evaluation (FCE) which could have been used to terminate the disability benefits.  By understanding current law and knowing how to read the policy fine print, WylieLaw was able to have our client avoid the FCE and ensure that he continued to receive his monthly disability benefits.
  • A dentist was diagnosed with various muscular diseases that made it impossible for him to stand or sit in the positions necessary to practice dentistry.  The insurance company denied his total disability claim stating the dentist had two jobs:  dentist and office administrator.  The insurance company agreed that the dentist was disabled from dentistry, but argued that he was not disabled from being an office administrator.  WylieLaw sued the insurance company in Federal Court and proved that the dentist had one occupation, general dentistry, and was totally disabled from that occupation resulting in back pay of all past due benefits and reinstatement of disability claim benefits.
  • An individual was receiving disability benefits for four years.  The insurance policy stated that after five years, the definition of disability would change. The insurance company offered the policyholder a buyout of the policy for a lump sum payment.  WylieLaw reviewed the policy, advised our client of his rights and entered into negotiations with the insurance company settling the matter for a much larger lump sum payment.
  • An individual, diagnosed with leukemia, was told by his insurance company that his coverage did not provide for certain medications and had other restrictions.  WylieLaw reviewed the insurance policy and found ambiguous terms and coverage discrepancies, which were subsequently communicated to the insurer.  The result: additional coverage for expensive medication and an extension of health insurance for a period significantly longer than the company had previously agreed.