Legal Question in Disability Law in California
Denial of supplemental insurance payment by Selfinsured Corp.
My company provides a supplemental insurance in my benifits package that I pay for. I recently went out on a disability that involved a mental illiness. After the first six weeks of disability the payments stopped and the company handling the insurance demanded all my Mental Health Medical records. I was also required to submitt a written appeal. The company has been reviewing my records to determine if I was disabled enough for their standards and if they are going to pay the policy. The company I work for is SelfInsured. I have learned there are no watch dogs for Self Insured Insurances. If they decided not to pay my only recource is to sue. My question is am I protected under the ADA because they are denying me benifits based on their determination that I was not disabled enough according to what ever criteria they have. I was also collecting State Disability that was payed promtly with no issues. the suplemental insurance I payed for the suplemental Iinsuarce by weekly deductions from my check. These companies are allowed to over rule doctors decisions as to who is disabled and who is not.It was made very plan to be by a Dept Of Labor spoksperson that the company handling the claim is only a pawn of the Self Insured Company.
1 Answer from Attorneys
Re: Denial of supplemental insurance payment by Selfinsured Corp.
This is not a matter that has any simple answer. Further, it is one that has little written about it. A lawyer needs to first confirm the disability and then initiate suit. If this were an insurance company you would be entitled to actual damages as well as punitive damages. The allowed damages may be greater against an insurance company, thus the issue is whether or not punitive damages would be available to you against the self insured.
GET A LAWYER knowledgable in insurance bad faith. ADA is a separate issue which may be explored but does not seem to be in point.
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