Until you try to collect your employer-provided long-term disability benefits, you may be under the impression that you could easily obtain those benefits. Unfortunately, the enactment of the federal Employee Retirement Security Act (ERISA) unintentionally created challenges when navigating claims for employer-funded disability insurance benefits without the guidance of an experienced Atlanta ERISA lawyer to educate you on your rights.
The ERISA was enacted to safeguard employee pensions and employer-funded benefits, which included:
- Disability Insurance
- Life Insurance
- Accidental Death and Dismemberment (AD&D) Insurance
Although originally intended to increase employee protections, the ERISA instead created numerous obstacles, with its strict claims procedures, for injured employees seeking insurance benefits. The ERISA also empowered insurance companies that have the authority to decide claims.
The ERISA, however, does not apply to all insurance claims. State laws and rules apply to personal and other non-ERISA insurance plans. A knowledgeable Atlanta ERISA lawyer can review your claim and discuss with you the relevant procedures and laws.
Disability Insurance Claims
Your ERISA disability insurance plan must explain its claim and appeal procedures in writing. Before filing a disability insurance claim, you should obtain a copy of your current Summary Plan Description (SPD) and Plan Document, both of which your employer or plan administrator must provide you. The SPD provides an overview of:
- Claim Procedures
- Disability Benefits
- Filing Deadlines
- Appeal Process
The Plan Document is more comprehensive compared to the SPD.
Your plan administrator could be your employer, an insurance company or other third party. When you file your ERISA disability insurance benefits claim, it is submitted to your plan administrator, who decides the outcome of your claim. Thus, it is crucial you strictly adhere to the claim procedures and filing deadlines outlined in both your SPD and Plan Document; otherwise, you could lose your disability benefits. You should include comprehensive information and evidence to support your disability claim. Since you are ultimately responsible for providing all supporting evidence of your claim, you should not rely on your plan administrator to conduct a thorough investigation, who has little incentive to do so. Your Atlanta ERISA lawyer can help you package a complete disability claim to increase your chances of success.
Once you receive written notice of your disability claim approval, you will receive your benefits. A written notice of denial is also important because it explains why you were denied and how you could appeal the decision.
Appealing a Denied ERISA Disability Claim
Here is how you can appeal a denial of your ERISA disability claim:
- File an administrative appeal with your plan administrator
- Abide by the strict appeal procedures
- Provide any additional or missing supporting evidence
If your appeal is denied, and you have “exhausted all of your administrative remedies,” you can then file a lawsuit in federal court. Your Atlanta ERISA lawyer will ensure you meet the strict appeal deadlines and other requirements.
Life Insurance Claims
Your loved ones may be entitled to your employer-funded life insurance benefits. The requirements are strict, however, and claims have been denied because of:
- Conflict over beneficiaries,
- Misrepresentation or nondisclosure, or
- Eligibility issues under the Plan Document, like ineligibility due to illegal drug use or suicide.
You could still be eligible for life insurance benefits even if your initial claim was denied. An experienced Atlanta ERISA lawyer can help recover the life insurance benefits you deserve.
Accidental Death and Dismemberment Insurance Claims
Employer provided AD&D applies if an employee’s severe injury or death is caused by an accident, but does not apply if such injury or death is due to an illness or “non-accident.” An experienced lawyer can review your AD&D plan and help you understand your rights.
Long Term Disability Insurance Claims
If you do not have disability insurance through your employer, you could have a personal long term disability insurance (LTD). Unfortunately it is not any easier to obtain LTD benefits because insurance companies frequently deny even valid LTD benefits claims. An Atlanta ERISA lawyer can review your policy, discuss your eligibility requirements, weigh your medical evidence, and help you file your claim or appeal. To be successful, it is crucial to submit supporting objective evidence that, depending on you policy, you cannot perform your job, or any job.
Bad Faith Insurance Claims
Insurance companies have duty to asses your claim in a fair and neutral manner. If not, they could be acting in bad faith. You could receive punitive damages if have a successful bad faith case. However, ERISA does not permit punitive damages for bad faith claims. Our knowledgeable lawyer can evaluate your bad faith claim and, if valid, maximize your compensation.
Speak to an Atlanta ERISA Lawyer
For assistance in filing your insurance claim or appeal, contact Atlanta ERISA lawyer J. Price McNamara for a free consultation at 504-458-8455.