It’s not until you actually apply for benefits through your employer-provided insurance policy that you may realize that the process is actually more complex. When the Federal Government enacted the Employee Retirement Security Act (ERISA), it unwittingly created obstacles for employees attempting to obtain ERISA insurance benefits. An Athens ERISA lawyer can help you navigate the complicated insurance claim and appeal processes to improve your chances of receiving benefits.
ERISA is a federal law intended to provide protections for privately employer-funded pensions and benefits, such as:
But the rigid claims and procedures had the side effect of creating more obstacles for employees filing for insurance benefits while the insurance companies that determine the outcome of the claims for insurance benefits were given increased powers instead.
Only the employer-provided insurance is subject to ERISA. The non-employer-provided insurance policies are subject to State rules and laws. An Athens ERISA lawyer can examine your policy, as well as assist you throughout your claims process for ERISA or non-ERISA insurance benefits.
Claim for ERISA Disability Insurance Benefits
Pursuant to ERISA, your disability insurance policy’s claim and appeal procedures must be in writing, which is usually provided in the Summary Plan Description (SPD) and Plan Document. Your employer or your plan administrator has an obligation to give you a copy of these documents.
The Plan Documents provides more details than the SPD, which summarizes the following:
- Claim Procedures
- Disability Benefits
- Filing Deadlines
- Appeal Process
Obtain a current copy of the SPD and Plan Document before you file a disability claim.
Your ERISA disability insurance claim will be filed with your plan administrator, who could be your employer, an insurance company, or other third party. To ensure you retain your rights to benefits, it is vital you follow the claims procedures and the filing deadlines. Since your plan administrator decides the outcome of your claim, it would be unwise to rely on the plan administrator to conduct a complete investigation. Because it is your burden to prove your disability, you must file all supporting evidence of your claim. Your Athens ERISA lawyer can help you file a comprehensive disability application or appeal, as well as abide by all procedures and deadlines.
Your benefits will follow a written notice of approval. If denied, the written denial will explain the reasons why you were denied and how to appeal the denial.
Appealing Denied ERISA Disability Benefits
You can appeal the ERISA disability benefits denial by doing the following:
- Filing an administrative appeal to your plan administrator
- Ensuring you adhere to the strict appeal procedures
- Supplementing with any missing or additional supporting evidence
If you have “exhausted all of your administrative remedies” and you are still denied benefits, your Athens lawyer can help you appeal to the Federal court.
Claim for ERISA Life Insurance Benefits
You may qualify for life insurance benefits from your deceased loved one’s employer if you meet all of the strict requirements. However, life insurance benefits have been denied over:
- Disagreement of beneficiaries,
- Misrepresentation or nondisclosure, or
- Conflict regarding eligibility (as defined by the Plan Document), e.g. not eligible because the loved one died from illegal drug use or suicide.
If your initial claim is denied, your Athens ERISA lawyer can help you with the appeal process. Or he can help you find other avenues of relief.
Claim for ERISA Accidental Death and Dismemberment Insurance Benefits
Employers may provide employees with AD&D insurance. To receive benefits, however, the employee must have been involved in an accident that resulted in severe injury or death. AD&D insurance does not apply if an illness or other “non-accident” caused the injury or death. A knowledgeable Athens ERISA lawyer can review the facts and circumstances of the employee’s injury or death and help you decide your best course of action.
Claim for Non-ERISA Long Term Disability Insurance Benefits
If you have a non-ERISA independent or private long term disability (LTD) insurance, you may find it obtaining benefits difficult. Even if your LTD claim is valid, insurance companies can still reject it. Our LTD lawyer can analyze your policy and evaluate your eligibility by examining your supporting medical evidence that shows that you are unable to, depending on your policy’s “disability” definition, perform the duties of your job or any job.
Claim of Bad Faith
There are times when an insurance company breaches it’s duty to fairly evaluate your claim. When this occurs, you may have a valid bad faith claim and be entitled to compensation. If the underlying insurance claim is not subjected to ERISA, you may also be entitled to punitive damages. We can examine the facts and circumstances of your underlying claim. We can also help you with your valid bad faith claim.
Speak to an Athens ERISA Lawyer
The potential for an approved ERISA or non-ERISA insurance claim for benefits exponentially improves with an Athens ERISA lawyer fighting by your side. Don’t hesitate; call J. Price McNamara at 504-458-8455 now for a free consultation.