ERISA Long-term disability (LTD) insurance is a crucial safety net for employees who may face extended periods of inability to work due to illness or injury. When these benefits are provided through an employer-sponsored plan, they often fall under the governance of the Employee Retirement Income Security Act (ERISA). This federal law sets standards for the administration of various employee benefit plans, including LTD insurance.

What is ERISA?

ERISA is the Employee Retirement Income Security Act of 1974. It is a federal law that governs most employee benefit plans.Although it was originally designed to protect retirement and pension benefits, it has been interpreted differently by the courts. ERISA is currently used as a shield by insurance companies to unfairly deny claims.

ERISA applies to benefit plans from private companies, partnerships, and proprietorships, no matter what their size or number of employees. Government employers and churches are exempted from ERISA’s provisions. There are several consequences of falling under ERISA. Here are some of them:

1. No jury trial
2. No trial in state court
3. No consequential damages
4. No punitive damages
5. No right to deposeexpert witnesses
6. No right to depose insurance company witnesses
7. No right to testifyon your behalf

Claim Denied!

Before any legal action can be taken, all administrative requirements under the plan must be met. The plan governs what procedure must be followed regarding your benefits. If a claim is denied, the plan will usually allow at least one appeal.The appeals process allows you to submit additional records and provide additional evidence supporting your disability.

The Appeal

An appeal may be written by you or by a lawyer.The appeals process can be complicated, and it is best to approach the appeal after fully understanding the issues involved in your denial. If you choose to handle an appeal on your own, it is strongly recommended that you consider the following issues:

1. If you are given the right to appeal, you must do so. The failure to appeal can be viewed as a failure to exhaust all remedies before filing suit.
2. Request a copy of the entire file relating to your claim, as well as the insurance policy, from the insurance company. You have the right to a free copy of this file.
3. Submit any additional records you have that would assist your claim. In most cases,this is your only chance to submit favorable evidence for your claim. Include any articles, journals,letters from your doctors or others who know about your condition, or anything else that would assist your claim. Once you file a lawsuit, the opportunity to provide new information is usually lost.

Appeal Denied

After you have exhausted all administrative remedies available within the plan, you have the right to file suit under ERISA. Unlike most civil suits, the courts will review the denial of benefits under a standard deferential to the insurance company. The insurance company’s denial will be upheld unless the court determines that it abused its discretion in its review of your claim. There are exceptions to this general rule. Understanding how to deal with common problems in long-term disability claims can be invaluable in navigating the process successfully.

For many claimants, a lawyer who is experienced in handling long-term disability claims can significantly improve their chances of receiving the benefits they deserve. Legal professionals can help claimants understand their policy terms, gather necessary evidence, and effectively challenge claim denials.

At Raval Trial Law, we understand the complexities of long-term disability claims and the challenges posed by insurance companies. We are dedicated to advocating for people who need help to secure the benefits they need and deserve. If you’re facing difficulties with a long-term disability claim, contact us to learn how we can assist you in navigating this challenging process and fighting for your rights.