There is a misconception that disabled American workers who cannot work can easily rely on their employer-provided long-term disability benefits. However, federal laws unfortunately make it challenging to obtain disability insurance benefits without the aid of a seasoned Fort Worth ERISA lawyer to educate you on your rights and help you throughout the claims and/or appeals process.
Congress intended the Employee Retirement Income Security Act (ERISA) to increase protections for employee pensions and other employer-funded benefits, such as:
- Life Insurance
- Disability Insurance
- Accidental Death and Dismemberment (AD&D) Insurance
However, the opposite effect is true: ERISA empowered insurance companies who approve or deny disability claims while employees seeking disability benefits must jump through numerous hoops.
Not all insurance plans are covered by ERISA. For instance, religious organization, non-profit or government employees may have non-ERISA plans. State laws and rules apply to personal disability insurance policies. A knowledgeable Fort Worth ERISA lawyer can educate you on the laws and procedures applicable to your claim.
ERISA Claims Process
ERISA mandates that your disability insurance plan’s claim and appeal procedures are explained in writing. 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 Plan Document. Before filing your disability insurance claim, you should request a copy of your SPD and the more detailed Plan Document. The SPD provides an overview of:
- 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, there is a high risk that your claim will be denied.
When filing your ERISA claim with your plan administrator, who approves or denies your claim, do not rely on the plan administrator’s investigation. You are responsible for providing all supporting evidence of your claim. Your Fort Worth ERISA lawyer can help you package supporting and comprehensive information and evidence to ensure your claim is fully developed.
If your claim is approved, you will receive a written approval notice and then begin receiving benefits. If the opposite occurs, you will receive a letter explaining why you were denied and how you can appeal the denial.
Denied ERISA Disability Claim
If you were denied ERISA disability insurance benefits, you can appeal by:
- Filing an administrative appeal with your plan administrator
- Complying with the appeal procedures outlined in your SPD
- Submitting additional or absent evidence before your plan administrator decides your appeal
You may file a lawsuit in federal court if you have “exhausted all of your administrative remedies” and your administrative appeal was denied. Since appeal deadlines are absolute, your Fort Worth ERISA lawyer will make sure you adhere to all the requirements to prevent denial due to a late filing or other technicality.
Long Term Disability Insurance Claims
Do not feel devastated if you were denied long term disability insurance (LTD) benefits. Insurance companies often deny valid LTD claims. A Fort Worth ERISA lawyer can explain your LTD benefits eligibility requirements, evaluate the strengths and weaknesses of your medical evidence, create a personalized strategy, and help you file your claim or appeal if your evidence supports your claim that you cannot execute your job, or, depending on your policy, any job.
Life Insurance Claims
If you lost a loved one, you may be entitled to employer-funded life insurance benefits; however, your claim could be denied if there is a:
- Conflict over who is entitled to the benefits,
- Nondisclosure or misrepresentation, or
- Problem of eligibility under the Plan Document (for instance, benefits is not permissible if your loved one died from illegal drug use or suicide).
Just because your initial life insurance claim was denied does not mean you are not entitled to those benefits. A proficient Fort Worth ERISA lawyer can evaluate your case and, if applicable, help recover your deserved life insurance benefits.
Accidental Death and Dismemberment Insurance Claims
Employers frequently provide employees with AD&D insurance, which pays benefits if an accident caused an employee’s death or severe injury. AD&D does not apply if the employee’s injury or death was caused by an illness or a “non-accident.” A skilled lawyer can educate you on your rights under the AD&D plan.
Bad Faith Insurance Claims
Insurance companies must fairly and neutrally evaluate your claim. They could be acting in bad faith if they don’t. You may be entitled to punitive damages if your bad faith claim is feasible; however, bad faith claims are not allowed under ERISA. An experienced attorney can evaluate your bad faith claim and maximize your damages.
Call a Fort Worth ERISA Lawyer
An experienced Fort Worth ERISA lawyer can review and help you with your disability insurance, life insurance, AD&D insurance and/or bad faith claim or appeal. Contact J. Price McNamara at 504-458-8455 today for a free consultation.