If you suffer a debilitating condition that prevents you from performing your job or any job, the last thing you want to worry about is fighting to obtain your employer-provided long-term disability insurance benefits. Unfortunately, federal laws make it challenging to obtain those benefits — especially without a seasoned El Paso ERISA lawyer by your side to help you navigate the claims and/or appeals process.
Federally enacted Employee Retirement Income Security Act (ERISA) safeguards employee pensions and other employer-funded benefits:
- Life Insurance
- Disability Insurance
- Accidental Death and Dismemberment (AD&D) Insurance
Although intended to increase employee protections, ERISA instead empowered insurance companies who approve or deny disability claims while employees seeking disability benefits must overcome numerous obstacles. Consequently, there is little incentive to approve claims when insurance companies know that the law favors them.
ERISA does not cover all insurance plans. For instance, if you are a religious organization, non-profit or government employee, you may have a non-ERISA plan. If you have a personal disability insurance policy, state laws apply. A knowledgeable El Paso ERISA lawyer can educate you on the laws and procedures applicable to your claim.
Processing ERISA Claims
Your disability insurance plan’s claim and appeal procedures must be explained in writing pursuant to ERISA. Your employer or plan administrator — who could a third party, an insurance company or your employer — must provide you with a current Summary Plan Description (SPD) and the more detailed and lengthier Plan Document. Before filing your disability insurance claim, you should request a copy of these documents. The SPD provides an overview of your:
- Claim Procedures
- Disability Benefits
- Filing Deadlines
- Appeal Process
If you fail to strictly comply with your claim procedures and filing deadlines as outlined in your SPD and Plan Document, your risk losing your right to disability benefits.
When filing your ERISA claim with your plan administrator, who determines the outcome of your claim, do not rely on the administrator’s investigation of your claim. You are responsible for providing relevant evidence. Your El Paso ERISA lawyer can help you compile comprehensive evidence to ensure your claim is fully supported.
If your claim is approved, you will receive a written notice and should then begin receiving benefits. If your claim is denied, you will receive a letter outlining the reasons for the denial and how you can appeal.
Appealing a Denied ERISA Disability Claim
You can appeal your denied ERISA disability claim by:
- Filing an administrative appeal with your plan administrator
- Abiding by with the appeal procedures outlined in your SPD
- Submitting additional or absent evidence before your plan administrator decides your appeal
After exhausting your administrative remedies, and if your claim is still denied, then your El Paso ERISA lawyer can file a lawsuit in federal court. It is imperative that you adhere to the strict appeal deadlines or the court will deny any late appeals.
Long Term Disability Insurance Claims
Insurance companies often deny valid LTD claims. If you have evidence that you cannot perform your job or any other, depending on your policy, you should file an appeal. An El Paso ERISA lawyer can explain your LTD benefits eligibility requirements, evaluate the strengths of your medical evidence, create a personalized strategy, and help you throughout the appeals process.
Life Insurance Claims
If your loved one is deceased, you may be entitled to life insurance benefits funded by the employer. Your claim could be denied if there is a dispute regarding:
- Who is entitled to the benefits,
- Nondisclosure or misrepresentation, or
- Eligibility under the Plan Document (benefits cold be denied if the death was caused by illegal drug use or suicide).
Just because your initial life claim was denied does not mean you are not eligible to those benefits. A proficient El Paso ERISA lawyer may help you recover the life insurance benefits you deserve.
AD&D Insurance Claims
Employers frequently provide employees with AD&D insurance. AD&D pays benefits if an accident, as opposed to an illness or a “non-accident,” caused an employee’s death or severe injury. A skilled Louisiana ERISA lawyer can educate you on your rights under the AD&D plan.
Bad Faith Insurance Claims
Insurance companies who do not fairly and neutrally evaluate your claim could be acting in bad faith. Some states permit punitive damages for bad faith claims. ERISA, however, does not permit bad faith claims. Your attorney can evaluate your bad faith claim, compile supporting evidence, and maximize your damages.
Call an El Paso ERISA Lawyer Today
If you intend to file a disability insurance, life insurance, AD&D insurance and/or bad faith claim or if your claim was denied, you need a tenacious El Paso ERISA lawyer to aggressively fight for your rights. Speak to J. Price McNamara at 504-458-8455 for a free consultation.