Disability Insurance Claim Denial Questions and Inquiries

Submit your insurance case review request or question:

Do you have a question about a disability, homeowners, automobile, long term care, life, health or other insurance claim? Please submit your question or case review request through this form.
Contact Information:
Name
Area Code + Phone Number (Day):
Area Code + Phone Number (Nights):
Area Code + Phone Number (other):
Best Time to Call:
E-mail Address:
State:	(Please use your State's 2 letter abbreviation)
Insurance Company:
Describe Your Problem:
Monthly Benefits:
Type of Policy:	Group Individual
Was your policy obtained through your employer?	Yes No
Name of employer at the time you purchased your policy:
Has your claim been wrongfully denied?	Yes No
When was claim denied?
Misc. Information
Verification	Please enter the characters from the image below to submit this form.

Click the Submit button and your message will be sent. If you do not receive a response within 2 working days please contact us by telephone.
Toll - Free 1.800.264.2082

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Law Offices of Bourhis & Mann
1050 Battery Street
San Francisco, CA 94111
Toll-Free Nationwide: 1.800.264.2082
e-mail: info@bourhis-mann.com

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