Many American workers have the misconception that they can easily rely on their employer-provided long-term disability benefits if they cannot work — until they try to collect those benefits. Federal laws unintentionally make it challenging to navigate disability insurance claims without the assistance of a knowledgeable Austin ERISA lawyer to help you comprehend your rights.
The Employee Retirement Income Security Act (ERISA) was enacted to protect employee pensions and other employer-funded benefits, such as:
- Life Insurance
- Disability Insurance
- Accidental Death and Dismemberment (AD&D) Insurance
Although intended to increase protections to employees, ERISA had the opposite effect. Insurance companies approving or denying disability claims were empowered while injured employees seeking disability benefits faced countless hurdles because they must follow strict claim procedures.
Notably, ERISA does not apply to all insurance plans. For instance, church, non-profit or government employees may have non-ERISA plans. For personal disability insurance policies, state laws and rules apply. A knowledgeable Austin ERISA lawyer can explain the laws and procedures that are relevant to your claim.
ERISA Claims Process
ERISA requires that your disability insurance plan explain in writing its claim and appeal procedures. Your employer or plan administrator — who could be your employer, an insurance company or a third party — must provide you with a current Summary Plan Description (SPD) and Plan Document, which you should request a copy of prior to filing a disability insurance claim. The Plan Document is more detailed than the SPD, which provides an overview of:
- Claim Procedures
- Disability Benefits
- Filing Deadlines
- Appeal Process
You risk losing your disability benefits if you fail to strictly comply with the claim procedures and filing deadlines outlined in your SPD and Plan Document.
Your ERISA claim submitted to your plan administrator, who approves or denies your claim, should contain comprehensive information and evidence in support of your claim. Do not rely on your plan administrator’s investigation. You are responsible for providing all supporting evidence of your claim. Your Austin ERISA lawyer can aide you compiling relevant evidence to fully develop your disability claim.
You will begin receiving benefits shortly after receiving a written notice of approval of your disability insurance claim. If denied, you will receive a written notice outlining why you were denied and your appeal process.
Denied ERISA Disability Claim
You can appeal your denied ERISA disability insurance benefit claim by:
- Filing an administrative appeal with your plan administrator
- Adhering to the appeal procedures set out in your SPD
- Submitting any additional or missing evidence before your plan administrator decides your appeal
You may file a lawsuit in federal court if you receive a denial for your appeal and you have “exhausted all of your administrative remedies.” Appeal deadlines are strict. Your Austin ERISA lawyer will therefore ensure that you meet all the requirements so your claim won’t receive a denial because of a late filing or other technicality.
Long Term Disability Insurance Claim
You could feel devastated if your long term disability insurance (LTD) benefits claim was denied. However, insurance companies frequently deny even valid LTD claims. An Austin ERISA lawyer can explain your eligibility requirements, assess your medical evidence’s strengths and weaknesses, develop a personalized strategy, and help you file your claim or appeal if you have supporting evidence that you cannot perform your job, or, depending on your policy, any job.
Life Insurance Claim
If you lost a loved one, you may be eligible to recover employer-funded life insurance benefits; however, the claim could be denied if there is a:
- Dispute over who is entitled to the benefits
- Misrepresentation or nondisclosure, or
- Issue of eligibility under the Plan Document (for example, denied benefits due to suicide or illegal drug use).
Just because your initial claim was denied does not equate to ineligibility of life insurance benefits. A skilled Austin ERISA lawyer can review your case and, if applicable, help recover the life insurance benefits you deserve.
Accidental Death and Dismemberment Insurance Claim
Many employers provide employees with AD&D insurance, which pays benefits if the employee is killed or severely injured due to an accident. AD&D does not apply if the employee’s death or injury was from an illness or a “non-accident.” An experienced lawyer can help you comprehend your rights under your AD&D plan.
Bad Faith Insurance Claims
Insurance companies have an obligation to fairly and neutrally assess your claim. Otherwise, they could be acting in bad faith. If you have a viable bad faith claim, you may be able to receive punitive damages. ERISA does not, however, permit bad faith claims. An experienced lawyer can investigate your bad faith claim and maximize your compensation.
Contact an Austin ERISA Lawyer
A seasoned Austin ERISA lawyer can help you file your disability insurance, life insurance, AD&D insurance and/or bad faith claim or appeal. Call J. Price McNamara at 504-458-8455 today for a free consultation.