ERISA Disability Insurance Lawyer
If you are injured or are suffering from a serious illness that prevents you from working, will you be able to collect benefits under your Short-Term or Long-Term Disability Insurance Policy? Will your insurance carrier abide by the policy terms and pay your claim? Your bills do not stop, just because you are unable to work. How will you proceed when you and your family's financial future is at stake?
Disability insurance policies are often written with ambiguous and confusing contract language. This provides insurance companies with the ammunition needed to deny and delay claims. Many group policies that you obtain as a result of your employment are governed by the Employees Retirement Income Security Act of 1974 ("ERISA"). ERISA is a federal statute that provides extremely strict deadlines and guidelines for claimants and insurance companies to abide by in the processing of a claim, submission of an appeal, and ultimately the determination of eligibility for benefits under a disability insurance policy.
ERISA creates an unequal claims process, placing strict regulations on claimants that make maneuvering a claim difficult and frustrating for unaware claimants at a time when they should be focusing on their recovery. The attorneys at Disability Insurance Law Group are dedicated to evening the playing field for our clients. We use our experience in handling these complex legal cases to guide our clients through the process and vigorously fight to protect our clients' rights.
These cases are highly technical and insurance companies spend great amounts of money to scrutinize and defend against these claims. It is essential that you choose an attorney with the knowledge and experience necessary to handle these complex legal issues. The attorneys at Disability Insurance Law Group encourage you to contact us if you are planning to file a disability insurance application, have filed, or have been denied benefits.
Defending Your Legal Rights
ERISA provides extremely strict deadlines and guidelines. If a claimant does not adhere to these strict guidelines and deadlines, the result can be disastrous for the claimant. Unfortunately, while insurance carriers are not free to ignore their obligations under ERISA, often claimants are unaware of their rights and violations often go unchallenged.
Unlike private disability policies, when a claim for disability benefits governed by ERISA is denied, the claimant MUST appeal directly to the insurance company that originally denied the claim. In some circumstances, a third party administrator reviews the appeal. However, ultimately the decision usually lies with the claimant's insurance company. While appealing to the insurance company that already denied your claim may seem like a fruitless effort, ERISA appeals should never be taken lightly. Most ERISA disability insurance claims allow the claimant 180 days from the date of receipt of a denial correspondence to appeal the insurance company's decision. While six months may seem like a long period of time, given the amount of information typically necessary to prepare an effective ERISA appeal, it is essential that you not waste a moment. The regulations that govern ERISA require insurance companies to explain to claimants that they have a right to appeal and provide additional information in an appeal and if the appeal is denied, they can file suit in Federal court. However, what claimants are not told can be the most important information. Insurance carriers do not explain that if you fail to appeal the denial within the 180 days provided, you will likely be barred from pursuing your claim further.
Moreover, insurance carriers typically do not tell claimants that they must prepare an entire trial during that 180 days provided to appeal the denial. This is because under most circumstances an ERISA disability insurance trial is based SOLELY on the information submitted prior to and with the ERISA appeal. Typically, if a claimant fails to provide any relevant information prior to or with the appeal and the insurance company upholds its denial of benefits, the claimant will be forever barred from bring forth the new evidence at trial. Thus, in most cases, it is essential that you prepare your trial in the six months that you have to appeal your insurance carrier's denial of benefits. This includes gathering all the evidence that a claimant would normally present during a lawsuit. Evidence brought forth at trial usually includes medical documentation, treating physician testimony, medical and vocational expert opinions, testimony from co-workers, friends, and family members that understand the claimant's condition and limitations, and employment documentation. A typical trial can take up to two years to properly prepare. As such, it is essential that claimants clearly understand the importance of the appeals stage and the time constraints that they are under.
Insurance companies do not provide this information to claimants because an uninformed claimant may sabotage their own claim. Most claimants would not choose to prepare for and present their case at trial without the assistance of an attorney. Unaware that they must prepare the case for trial at the appeals stage, many claimants decide to try to overturn the decision on their own, with the intention of retaining an attorney if the denial is upheld. If the claimant did not submit all the necessary information, they may have destroyed their claim or dangerously lowered their chances in a lawsuit.
Moreover, insurance carriers will often explain that certain information was missing. This induces many claimants to simply gather the outstanding information as their appeal. Many claimants merely submit a letter from their treating physician disputing the disability insurance carrier's determination and / or updated medical records. Oblivious of the rights they are giving up, many truly disabled individuals severely damage their claims for benefits. Most individuals would be weary of basing their entire lawsuit on the meager evidence described above. However, typically if the claimant pursues benefits at trial, they will be limited to the application, the few medical records, and the letter from the treating physician. Expert medical opinions cannot be added to dispute the insurance carrier's assertions, testimony from co-workers and friends will be excluded, and the claimant will not be allowed to tell their story. While under certain limited circumstances the administrative record can be re-opened, allowing additional information in, it is essential that you understand the possible damage that can be done to your claim by failing to prepare an effective and thorough appeal of an ERISA governed disability insurance claim.
Many claimant's, unaware of this fact, merely submit a letter from their treating physician disputing the disability insurance carrier's determination and / or updated medical records. Oblivious of the rights they are giving up, many truly disabled individuals severely damage their claims for benefits. Most individuals would be weary of basing their entire lawsuit on the meager evidence described above. While under certain circumstances the administrative record can be re-opened, allowing additional information in, it is essential that you understand the possible damage that can be done to your claim by failing to prepare an effective and thorough appeal of an ERISA governed disability insurance claim.
Insurance carrier's typically have 45 days to make a decision on your ERISA appeal. Insurance carriers are also allowed to take an extension of up to 45 days for good cause shown. Moreover, under most circumstances, insurance companies are limited to the original reasons set forth in the first denial of benefit correspondence and are not allowed to put forth new reasons for a denial of benefits if no additional appeals are provided to the claimant. Often violations of these requirements go unchallenged because claimants are unaware of their rights.
Not all group disability insurance claims are governed by ERISA. However, because of the strict guidelines and deadlines that ERISA places on claimants, many insurance carriers assert that the claim is governed by ERISA, even if it clearly meets one of these exceptions. If claimants are unaware that their claims are not governed by ERISA, they may be unnecessarily delaying the payment of benefits or unknowingly giving up many rights. However, if a claimant is unsure of whether their claim actually falls under ERISA, it is highly recommended that they seek advice before disregarding any ERISA deadlines.
Navigating the ERISA Process
The Attorneys at Disability Insurance Law Group are dedicated to using their knowledge and experience in handling these complex legal issues, to vigorously fight to protect our clients' rights. Many denials can be overturned prior to litigation, by effectively preparing an ERISA appeal. However, if an insurance company refuses to overturn its wrongful and unreasonable denial, we will aggressively fight to obtain all benefits owed to our clients in a court of law.
Additional Information:
Applying for Disability Insurance Benefits
Benefit Denial Options
ERISA Appeals
Private v. Group Disability Policies
Frequently Asked Questions
Recent Articles & News Clips
Contact our office to arrange for a free initial consultation. One of our attorneys will listen to your concerns, evaluate your case, and advise you of your legal options.
Disability Insurance Law Group
(a partnership of Flowers Paulino-Grisham, P.L. and Chmielarz & Smith, P.A.)
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TOLL FREE NATIONWIDE: 1-888-644-2644
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Palm Beach (Lantana)
1111 Hypoluxo Road
Suite 110
Lantana, FL 33462
561-202-9170
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Dade: (Miami Lakes)
5803 NW 151st Street
Suite 200A
Miami Lakes, FL 33014
305-820-0800
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Broward: (Presidential Circle, Hollywood)
4151 Hollywood Boulevard
Hollywood, FL 33021
954-351-7688
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1111 Hypoluxo Road
Suite 110
Lantana, FL 33462
Telephone: 561-202-9170
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Toll Free: 1-888-644-2644
Our firm serves clients throughout the state of Florida and the United States, including the cities of West Palm Beach, Miami, Fort Lauderdale, Palm Beach Gardens, Jupiter, Naples, Fort Myers, Orlando, Tampa, Jacksonville, Tallahassee, and Panama City; as well as the following counties: Palm Beach County, Miami-Dade County, Broward County, Orange County, Hillsboro County, Devon County, and Leon County.
