Most American employees are confident they can rely on their employer-provided long term disability benefits if they cannot work due to injuries; that is, until they try to collect those benefits. Without legal assistance, Federal laws make navigating disability insurance claims difficult. In addition, insurance companies don’t make the process any easier. A Dallas ERISA lawyer can help you understand your rights and how best to present your claim.
Federal law Employee Retirement Income Security Act (ERISA) was intended increase protections for employee pensions and other employee-funded benefits such as:
- Life Insurance
- Disability Insurance
- Accidental Death and Dismemberment Insurance
Unfortunately, insurance companies who have the authority to approve or deny disability benefits were empowered under ERISA while injured employees seeking disability benefits became subject to numerous obstacles.
ERISA does not cover all insurance plans. For example, a church or government employee may have a non-ERISA plan. Additionally, state rules and laws apply to personal disability insurance policies. A Dallas ERISA lawyer will help you understand the applicable laws and procedures relevant to your claim.
ERISA Claims Process
ERISA requires that your employer-provided disability insurance plan must explain, in writing, its claim and appeal procedures. Before filing a disability insurance claim, request a copy of your current Summary Plan Description (SPD) and Plan Document, which must be provided by your employer or plan administrator. An SPD gives you an overview of:
- Claim Procedures
- Disability Benefits
- Filing Deadlines
- Appeal Process
You risk losing your disability benefits if you do not strictly follow the filing deadlines and claim procedures outlined in your SPD and Plan Document. Your plan administrator (who may be your employer, an insurance company, or a third party) has approval and denial authority over your claim.
The filed ERISA claim submitted to your plan administrator should have detailed information and evidence, such as medical records. Do not rely on your plan administrator’s investigation. You are responsible to provide all supporting evidence of your claim. Your Dallas ERISA lawyer can help you compile the evidence to fully develop your claim.
If your disability insurance claim is approved, you will receive a written notice and, shortly thereafter, begin receiving benefits. If denied, you will receive a letter that explains the reasons for the denial and information on the appeal process.
ERISA Disability Claim Denied
Your denied ERISA disability benefit claim can be appealed. You must first “exhaust your administrative remedies” before filing a lawsuit against an ERISA plan, by:
- Adhering to your SPD’s appeal procedures,
- Filing an administrative appeal with your plan administrator, and
- Submitting any missing or additional evidence before your plan administrator decides your appeal
You may file a lawsuit in federal court if you have exhausted all your administrative remedies and your appeal is denied. Late appeals will be denied due to the strict appeal deadlines. Your Dallas ERISA lawyer will assure all requirements are met.
Long Term Disability Insurance Claim Denied
Unfortunately, valid long term disability insurance (LTD) benefits claims are frequently denied. If you have evidence that you cannot perform your current job or, depending on your insurance plan, any job, then you should appeal your denial. A Dallas ERISA lawyer can help you comprehend your plan’s eligibility criteria, your medical evidence strengths and weaknesses, and the appeal process. A personalized strategy may become the difference between obtaining the benefits you deserve and a denial.
Life Insurance Claim Denied
If you lost someone you loved, you may be entitled to receive employer-funded life insurance benefits. However, the plan administrator may deny your life insurance claim if there is a:
- Nondisclosure or misrepresentation,
- Dispute over those entitled to the benefits, or
- Eligibility issue under the Plan Document (for example, denied benefits because of illegal drug use or suicide).
Denial of your initial claim does not automatically equate to ineligibility of life insurance benefits. An experienced Dallas ERISA lawyer can help recover your life insurance benefits.
Accidental Death and Dismemberment Insurance Claim Denied
Employees are often provided Accidental Death and Dismemberment (AD&D) insurance from their employers. Employees are entitled to AD&D benefits if the employee is killed or severely injured from an accident, rather than an illness or “non-accident.” A skilled lawyer can help you understand your AD&D policy.
Bad Faith Insurance Claim Denied
Insurance companies are required to assess your claim fairly and neutrally. They could be acting in bad faith when they do not. Many states allow punitive damages if the insurance company acted in bad faith; however, ERISA does not allow for bad faith claims. An knowledgeable attorney can review and investigate your bad faith claim; and, maximize the compensation you deserve.
Call a Dallas ERISA Lawyer
A seasoned Dallas ERISA lawyer can assist you in preparing and filing your disability insurance claim or appeal. Contact J. Price McNamara today at (504) 458-8455.