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Kevin M. Zietz is one of the most experienced lawyers in Los Angeles handling ERISA matters, Mr. Zietz is dedicated to helping clients with issues involving the denial of disability benefits, long term care benefits, health insurance benefits, and life insurance benefits.
If you receive your disability, health, or life insurance through your employer, your claim is likely governed by ERISA (the Employee Retirement Income Security Act of 1974), a federal statute that provides extensive rules effecting transactions associated with employee benefit plans. Kevin M. Zietz has successfully handled disability claims, health insurance claims, and life insurance claims against many of the major insurance companies in the United States, helping clients obtain the benefits which they are entitled.
Kevin M. Zietz also represents people who purchase individual policies (outside of work) that have been denied disability benefits, long term care benefits, health benefits, and life insurance benefits.
The Law Offices of Kevin M. Zietz offers free and confidential legal consultations and Kevin M. Zietz will explain the process and help you understand your rights.
If you or someone you know needs a dedicated and experienced lawyer to help obtain benefits from an insurance company, call The Law Offices of Kevin M. Zietz at 818-850-0906 or 866-927-8188, or complete the contact form provided on this site to schedule your free consultation.
Kevin M. Zietz has been helping clients who have had their benefits denied by an insurance company for more than 15 years. Mr. Zietz represents clients who have had their insurance company deny long term disability benefits, health insurance benefits or life insurance benefits. Whether you have an individual policy of disability, health or life insurance that you purchased on your own, or if you have coverage because you are part of a group plan offered through your employer, Mr. Zietz can help you get your benefits.
If your claim has been denied and the insurance company has offered you the opportunity to appeal the decision, Mr. Zietz can help prepare the appeal. When your benefits are offered through a group plan available by your employer, federal law requires that you exhaust your administrative remedies by completing the appeal process before you can file a lawsuit (in Federal Court) against your insurance company.
If you or someone you know needs the assistance of an experienced ERISA attorney, call The Law Offices of Kevin M. Zietz today at 818-850-0906 or 866-927-8188, or complete the contact form provided on this site to schedule a free consultation.
Attorney Kevin M. Zietz, Esq.
- Licensed to practice law in California
- Admitted to the Bar in December 1996
- Graduated from University of California, Santa Barbara, B.A., in 1991
- Member of Consumer Attorneys of Los Angeles (CAALA)
- Member of Consumer Attorneys of California (CAOC)
The largest area of Kevin M. Zietz's insurance litigation practice is devoted to helping clients obtain long term disability benefits denied by their insurance companies. Disability insurance is intended to replace between 50%-70% of an individual's income when they are unable to work. Insurance companies sell disability insurance to policyholders on the promise that the company will protect the policy holder and their family in the event that he / she becomes sick or is injured and cannot work. In this situation, someone who is disabled has to worry about how to pay their bills and maintain their standard of living.
If you have purchased an individual policy of disability insurance, the company owes you a duty of good faith and fair dealing. That means that the company has a duty to protect the interests of the people they insure in the same way they protect their own interests.
If you have disability insurance that was provided through a group disability plan available through your employer, your claim most likely falls under the jurisdiction of the Employee Retirement Income Security Act of 1974 (ERISA). This law allows the plan's claim administrator to decide if a claimant is disabled. We can help prepare and submit the appeal, which is required by ERISA. If the denial is not reversed on appeal, we file a lawsuit in federal district court against the disability plan and the insurance company and pursue your benefits through litigation.
We have handled cases with success against the following insurance companies:
It can be a complicated and stressful experience dealing with health insurance and how it covers your medical bills. You may have a Preferred Provider Organization (PPO) Plan that pays medical bills after they are incurred or you may be covered under one of the many varieties of Health Maintenance Organization (HMO) Plans that "pre-authorize" certain treatments and disallow others.
Traditional health insurers are licensed and regulated by the Department of Insurance under the Insurance Code. But, HMOs are specifically exempted from the jurisdiction of the Department of Insurance and the Insurance Code. Instead, HMOs are licensed and regulated by the California Department of Managed Health Care.
Whether you have a PPO or HMO, your health insurance company owes you a duty of good faith and fair dealing. That means that the company has a duty to protect the interests of the people they insure in the same way they protect their own interests. The company has to act fairly and move quickly to resolve claims.
Post Claim Underwriting and Rescission
In California, companies that provide medical insurance must review the application for insurance at the time the policy is written. Insurance companies cannot wait until the insured submits a claim and then review the application for an excuse to rescind or cancel the policy. This is an illegal practice called post claims underwriting. It not only violates the statutory law but it is also a violation of the insurance companies' duty of good faith and fair dealing to the policyholder.
If your health insurance company refuses to pay a medical bill, authorize medical treatment, or unlawfully rescinds or cancels your policy after you have submitted a claim, we can help.
Life Insurance Benefits Denied?
People purchase a life insurance policy because they take the well being of their family into account. A life insurance policy is a contract between the policyholder and the life insurance company which requires the life insurance company to pay their beneficiaries a certain amount of money if the policyholder passes away. Life insurance policies typically pay the death benefit proceeds according to the beneficiary structure of the policy. There are occasions where the benefits are not paid as directed by the policy. One example is if all beneficiaries precede the primary insured in death, or the primary insured and all beneficiaries die concurrently.
The life insurance application is part of the policy. When a person applies for life insurance, the life insurance company reviews the application and determines if they will insure the applicant, and for how much their life will be insured.
Many states have regulations that prohibit a life insurance company from denying the payment of death benefits if the decedent died more than 2 years after the issuance of the policy. However, when the policyholder passes away within 2 years of the policy's issuance, the company will usually investigate to see if it can find a way to deny the claim. If even the slightest mistake is found, the company will attempt to deny coverage and will send back a check for the premiums already paid.
The most common way life insurance companies are able to deny claims on a valid policy where the policyholder passes away within two years is through a "material misrepresentation” within the insurance application - the intentional or negligent concealment of a fact. Material misrepresentations are any discrepancies or distortions in the application that would have caused the life insurance company to not accept the risk and issue the policy had they been known at the time of approval. Material misrepresentations must be misrepresentations in the insurance application that are material enough to cause a life insurance company to deny a life insurance claim.
If you have purchased an individual life insurance policy, the company owes the beneficiaries a duty of good faith and fair dealing. That means that the company has a duty to protect the interests of the people they insure in the same way they protect their own interests.
If you have life insurance that was provided through a group life insurance plan offered through the insured's employer, the claim falls under the jurisdiction of the Employee Retirement Income Security Act of 1914 (ERISA). This law allows the plan's claim administrator to decide if a claim should be paid. The remedies available in ERISA cases are limited to the benefits owed and, in the court's discretion, interest on past benefits due and reasonable attorney's fees. We can help prepare and submit the appeal which is required by ERISA. If the denial is not reversed on appeal, we file a lawsuit in federal district court against the life insurance plan and the insurance company and pursue your benefits through litigation.
Long Term Care Insurance
Long term care insurance (LTC or LTCI) helps pay the cost of long term care which generally is not covered by health insurance, Medicare, or Medicaid.
Individuals who require long term care are not sick in the traditional sense. Instead, they are unable to perform the basic activities of daily living (ADLs) such as dressing, bathing, eating, toileting, getting in and out of bed, and walking.
Long term care insurance generally covers home care, assisted living, adult daycare, respite care, hospice care, nursing home and Alzheimer's facilities.
The insurance company knows that most of the time people in need of these insurance benefits do not have the strength or ability to fight the insurance company. What often times happens is that once benefits are denied, people give up and the insurance companies end up with all the premiums without having to pay benefits.
If you, a friend or a loved one has been denied long term care benefits, we can help.
Call for a free consultation today at 818-850-0906 or 866-927-8188.