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It looks like my disability insurance claim is going to be denied. What type of attorney and what kind of fee structure?

San Diego, CA |

I was a self employed dentist. I have had private disability ins. for years. Over the last 5-6 years I have had increased dexterity and pain problems due to cervical stenosis. I reached a point where it was impossible to continue. I advertised a "disablility" sale of my practice and a buyer responded. I filed a claim for total disability. The adjuster has said that the claim will probably be denied but needs me to send him a huge amount of records, sales agreements, tax returns, production reports, etc. I want an attorney to look this over. My search with local referral networks has not been effective. Do I need an insurance specialist (most seem to deal only with SSI) or can a general practice attorney handle this?

Attorney Answers 5


  1. Definitely get someone whose practice focuses on these sorts of claims. There are certain things to look for and be wary of for these claims. What the adjuster is asking for is not a surprise, and probably not unreasonable.

    Regardless, definitely get someone who knows this area of the law. You do yourself a disservice by settling for a general practitioner, no matter how competent they are.

    I have handled many claims just like yours, i.e. dentists with private policies, and often with back and neck problems. I am happy to provide a free consultation toll free at 877-631-0330.


  2. The critical threshold determination is whether your policy is governed by ERISA. If so, you need an ERISA attorney and not general insurance defense or disability counsel. ERISA is very complicated, esoteric, and counter-intuitive. Most ERISA attorneys accept cases on contingency and most will give a short consultation sufficient to identify whether ERISA is the applicable law as to your coverage.

    My responses to questions on Avvo are never intended as legal advice and must not be relied upon as legal advice. I give legal advice only in the course of an attorney-client relationship. Exchange of information through Avvo's Questions forum does not establish an attorney-client relationship with me. That relationship is established only by individual consultation and execution of a written agreement for legal services.


  3. So sorry to hear about your situation. I would think you need an attorney experienced with disability and coverage insurance/claims as well as elements of employment law. I have a recommedation for you in San Diego if you contact me. You should stop dealing with the insurance adjuster yourself and retain an attorney experienced in this area(s) of law. I wouldn't give myself a root canal!

    Legal disclaimer:This message does not constitute legal advice and does not create an attorney-client relationship. Any statements are made for general informational purposes and do not constitute legal advice. No attorney-client privilege is created by this communication. Attorney is licensed in California only.


  4. If you have a group policy it is most likely covered by the federal law known as ERISA (Employee Retirement Income Security Act) and you need an attorney specializing in ERISA claims. If it is an individual policy that you purchased then it most likely is covered by California State insurance law. In that case you need an attorney experienced in civil litigation and insurance disability claims (as opposed to social security disability and workers comp claims). There are several attorneys locally that deal with insurance disability claims but very few that deal with ERISA claims. My firm deals in both.


  5. If you have a private disability policy, you should seek an insurance lawyer experienced in disability policies. If you have a group policy, you will need a lawyer specialized in ERISA. ERISA has many administrative deadlines and other policies that must be complied with.

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