Bad Faith Insurance Claims: Submit Case

Find lawyers handling Denial of Private Disability Coverage

We handle claims by individuals for non-payment and termination of payment long-term disability (LTD) benefits. We also represent people in denials of benefits under long-term disability plans, ERISA and Non- ERISA (private and public employee group plans).

If you or a family member has suffered a serious illness or been disabled and subsequently denied benefits, use this form to find an attorney. Bad faith claims are a frequent cause for legal action.

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Title:
* First Name:
M. I.
* Last Name:
Address:
City:
State:
Zip Code:
* Phone Number (day):
Phone Number (eve):
* Email Address
If the shares were not bought in your name, please tell us the name of the person:
Title:
First Name:
MI
Last Name:
What is this person's relationship to you?:
Affected person's date of birth?: ie (mm/dd/19yy)
Have you or they been denied long-term disability benefits or had benefits terminated?	Yes No
Were you denied by Social Security or a private insurance carrier?	Social Security Private Carrier
If private insurance carrier, what was the name of your carrier?
What was the estimated date of the denial?
What reason were you given for the denial?
Have you signed up for any type of reassessment program?	Yes No
Have you received any type of lump sum settlement?	Yes No
What was your monthly benefit payment excluding State disability, Worker's Compensation and Social Security?
What was your monthly benefit payment including State disability, Worker's Compensation and Social Security?
Did you have a group or individual policy?:
What is your disabling condition?
Have you returned to work since you originally filed the claim?	Yes No
Do you currently have an attorney assisting you in this matter?	Yes No
Please briefly describe your benefit issue and legal concern
I understand that submitting this form does not create an attorney client relationship: Agree

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