Many of us have Long-Term Disability benefits, either by virtue of employment or through purchased insurance policies. While the hope is to never need our Long-Term Disability benefits, life often has other plans for us.
When you really need Long-Term Disability insurance, all too often, it’s not there for you. If you’ve found yourself in the unexpected position of needing Long-Term Disability benefits, the road ahead can be difficult. Insurance companies and claims administrators often act against your best interests and find ways to deny otherwise valid claims.
That’s when our team can help.
If you’ve received a denial or termination of your Long-Term Disability benefits, or if you just need advice on submitting a claim, contact us for a free consultation. You may feel like you have nowhere to turn and are unsure of what to do next. Before making any decisions that could have serious implications for your benefits and future, you should speak with one of our attorneys. No matter the reason you need Long-Term Disability benefits, we want to help answer your questions.
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The Employee Retirement Income Security Act of 1974 (ERISA) is a federal statute that was designed to protect participants of employee pension plans and other benefit plans offered by employers, such as Long-Term Disability benefits. Unfortunately, in its current legal state, ERISA offers more protection to insurance companies than to the participants it was intended to protect. If your Long-Term Disability benefits are governed by ERISA, or if you’re unsure if ERISA applies, you should contact our team today. Under ERISA, plan participants may seek relief for breaches of fiduciary duty, denial of benefits, or failure to disclose plan terms or benefits changes. However, if state law applies, then you could have a claim for insurance bad faith. Determining whether ERISA applies to your claim is a question of law best assessed by one of our attorneys. The insurance company will often misclassify benefits as governed by ERISA when, in fact, they are subject to state law.
In an ERISA case, you’re generally required to exhaust the administrative appeals process before bringing a lawsuit. This means you must appeal directly with the insurance company or claim administrator and submit evidence in support of your claim. You also have a right to all relevant documents used in your claim, so that you can “perfect” your claim. Currently, the Department of Labor is reviewing ERISA claims regulations, so the rules for appealing may change. Unlike other areas of the law, the evidence you are allowed to present in court on an ERISA matter is often limited to the evidence you submit during your appeal. If you do not appeal, or fail to do so timely and carefully, you could forever lose your right to benefits. Because of the question as to applicable law, relevant regulations, and the overall importance of submitting appeals, you should consult one of our attorneys. Submitting the best evidence possible is critical to your success on appeal.Beware of online resources offering advice on appealing your denial of disability benefits. These resources often give incorrect advice about appeals and vary, depending on where you live. If you have questions about appealing a determination on your Long-Term Disability benefits, contact our team for a free consultation today.
Insurance companies deny or terminate claims for many reasons. One common reason is the purported failure to meet the definition of “disability.” Many Long-Term Disability policies have changes in the definition of “disability” after 24 months of benefits, requiring you to be disabled not just from your “own occupation,” but from “any occupation.” The insurance company will frequently “cherry pick” your medical records, even retaining an “independent” medical reviewer to build evidence against you, despite the fact that you’ve never been personally evaluated by that reviewer.Although the road ahead can seem difficult, don’t give up on your right to your disability benefits. Insurance companies often count on you not fighting your benefits, thus saving them from paying you for the months – and often years – of benefits to which you’re entitled.
Don’t give up! If ERISA applies, you have 180 days to appeal. Further, you may have additional appeal processes under your policy. Even if you have already appealed,
it’s not too late to contact one of our attorneys to discuss your right to benefits or right to bring a lawsuit. Contact us today to get started with a FREE consultation.