Florida ERISA Lawyer
Many workers in America are confident that if they lose the ability to work because of injuries they have sustained, they will at least be able to depend on long-term disability benefits provided by their employers. However, that confidence goes away when they attempt to collect those benefits. Federal laws often make disability insurance claims difficult to navigate, especially without the assistance of a legal professional. If your medical conditions are disabling, you need a Florida ERISA lawyer. He can help you understand your rights before you file a claim or appeal.
What Is ERISA?
The Employee Retirement Income Security Act (ERISA) is a federal law that protects employee pensions and other benefits, including employer-funded:
- Disability insurance
- Life insurance
- Accidental Death and Dismemberment Insurance
Although ERISA was originally intended to give increased protection to employees, the plan completely backfired. Instead of helping injured workers collect their disability benefits, ERISA places countless hurdles in front of them that make it extremely difficult. Moreover, the law gives more power to the insurance companies that approve or deny claims. Since insurance companies know that the law favors them, they consequently have even less incentive to approve claims.
You must follow specific claim procedures if you are covered by an ERISA plan. However, not all insurance plans are covered by ERISA. State laws and rules apply if you have a personal disability insurance policy. Furthermore, if you are a government or church employee, you may have a non-ERISA plan. In order to understand which laws and procedures apply to your claim, speak to your Florida ERISA lawyer.
How Will They Process My ERISA Claim?
Under ERISA, your disability insurance plan must explain its claim and appeal procedures in writing. Before you file a disability insurance claim, you should request copies of your current Summary Plan Description (SPD) and Plan Document. An SPD provides an overview of:
- Your disability benefits
- Claim procedures
- Filing deadlines
- The appeal process
The Plan Document is longer and more detailed. Your employer or plan administrator must provide you with these documents.
You must follow the exact claim procedure set out in your SPD and Plan Document. If you do not meet the plan’s filing deadlines, you may lose your right to disability benefits. This is true if you ignore the plan’s claim procedures as well. A plan administrator will either approve or deny your claim. Typically, the plan administrator is an insurance company; it may, however, be your employer or someone else.
When you file an ERISA claim, you should give the plan administrator detailed information, including evidence such as medical records. It is your responsibility to provide evidence supporting your claim; you should therefore not rely solely on the plan administrator’s investigation. Your Florida ERISA lawyer will help make sure that you fully develop your claim.
If the administrator approves your disability insurance claim, you will receive a written notice. Your benefits should begin shortly thereafter. If the plan administrator denies your claim, you should get a denial letter that explains the reasons for your denial and sets out the appeal process.
What If the Administrator Denies My ERISA Disability Claim?
If the administrator denies your claim, you can appeal. However, you cannot immediately file a lawsuit against an ERISA plan. Rather, you must “exhaust your administrative remedies.” This means that you must:
- File an administrative appeal with your plan administrator
- Follow the appeal procedures in your Summary Plan Description
- Submit any additional or missing evidence before the plan administrator issues a decision on your appeal
Once you exhaust your administrative remedies, you can file a lawsuit in federal court. However, keep in mind that the court has strict appeal deadlines; any late appeals will be denied. Your Florida ERISA lawyer will make sure that you meet these requirements.
Long Term Disability Insurance Claim Denials
When your long term disability (LTD) benefits are denied, it can be devastating. Unfortunately, however, insurance companies deny valid LTD claims all the time. If you have evidence that you cannot perform your job or all jobs (depending on your plan), you should file an appeal.
A Florida ERISA lawyer can help you understand your plan’s eligibility criteria, appeal process and the strength of your medical evidence. A personalized appeal strategy may be the difference between another denial and the benefits you deserve.
Life Insurance Claim Denials
If you have lost a loved one, you may be able to receive company-funded life insurance benefits. However, if there is a dispute over one of the following, a plan administrator may deny your life insurance claim:
- Who is entitled to the insurance benefits,
- Misrepresentation or nondisclosure, or
- Eligibility under the Plan Document (for example, benefits may be denied in cases of suicide or illegal drug use).
If the insurance company or plan administrator denies your initial life insurance claim, don’t assume that you are ineligible for life insurance benefits. By working with an experienced Florida ERISA lawyer, you may be able to recover the benefits you deserve.
Accidental Death and Dismemberment Insurance Claim Denials
Accidental Death and Dismemberment (AD&D) insurance is frequently provided by employers. AD&D pays benefits if an employee is killed or severely injured in an accident. However, illnesses and other “non-accidents” are not covered by AD&D policies. If you are denied AD&D benefits, your lawyer can help you understand your rights under your AD&D plan.
Bad Faith Insurance Claim Denials
A plan administrator may deny an insurance claim in bad faith. Insurance companies have a duty to evaluate your claim fairly and without bias. If you have evidence of plan administrator misconduct, in many states you may be eligible for punitive damages. (Unfortunately, ERISA does not allow bad faith claims.) A skilled lawyer can help you evaluate your claim. He can also compile evidence showing that the insurance company acted in bad faith and maximize your compensation.
Call Today to Speak to a Florida ERISA Lawyer
If you received a disability claim denial, Florida ERISA lawyer J. Price McNamara can help you file an appeal. Contact us today to start the process.