Georgia ERISA Lawyer
Many American workers believe that if they suffer injuries and as a result are no longer able to work, they will at least be able to depend on their employer-provided long-term disability benefits. That is, they are believe it until they try to collect those benefits. Federal laws often make disability insurance claims difficult to navigate, especially without legal help. If your medical conditions are disabling, you need a Georgia ERISA lawyer to 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, and
- Accidental Death and Dismemberment Insurance.
Although the government originally intended ERISA to provide enhanced protection to employees, you likely know by now that the plan backfired. ERISA actually places countless hurdles in front of injured workers trying to collect their disability benefits. And this is while further empowering the insurance companies that approve or deny their claims. Consequently, since insurance companies know that the law favors them, they have little incentive to approve claims.
If you are covered by an ERISA plan, you must follow specific claim procedures. However, ERISA does not cover all insurance plans. If you have a personal disability insurance policy, state laws and rules apply. Moreover, if you are a government or church employee, you may have a non-ERISA plan. A Georgia ERISA lawyer can help you understand which laws and procedures apply to your claim.
How Do ERISA Claims Get Processed?
Under ERISA, your disability insurance plan must explain in writing its claim and appeal procedures. Before you file a disability insurance claim, make sure to request copies of your current Summary Plan Description (SPD) and Plan Document. While the Plan Document is longer and more detailed, a Summary Plan Description provides an overview of your:
- disability benefits,
- claim procedures,
- filing deadlines, and
- appeal process.
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 don’t meet the plan’s filing deadlines or ignore its claim procedures, you may subsequently lose your right to disability benefits. A plan administrator will either approve or deny your claim. Typically, the plan administrator is an insurance company. However, it may be your employer or someone else.
When you file an ERISA claim, you should give the plan administrator detailed information and evidence, including medical records. As your Georgia ERISA lawyer will tell you, you have a responsibility to provide evidence supporting your claim. You should not rely solely on the plan administrator’s investigation.
If the administrator approves your disability insurance claim, you will receive a written notice and your benefits should begin shortly afterwards. If the administrator denies your claim, you will get a denial letter that explains the reasons for your denial. The letter will also set out the appeal process.
What If the Administrator Denies My ERISA Disability Claim?
If your claim is denied, you can appeal. However, you cannot immediately file a lawsuit against an ERISA plan. Instead, 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 SPD, and
- submit any additional or missing evidence before the plan administrator issues a decision on your appeal.
Once you exhaust the administrative remedies available to you, your Georgia ERISA lawyer can file a lawsuit in federal court. However, keep in mind that there are strict appeal deadlines. The court will deny any late appeals.
Long Term Disability Insurance Claim Denials
Insurance companies frequently deny valid LTD claims. When this happens, it can be devastating. If you have evidence that you cannot perform your job or all jobs (depending on your plan), you should file an appeal. A Georgia ERISA lawyer can help you understand your plan’s eligibility criteria. He can also help you navigate the appeal process and assess the strength of your medical evidence. A personalized appeal strategy may be the difference between another denial and the benefits you deserve.
Accidental Death and Dismemberment Insurance Claim Denials
Employers frequently provide Accidental Death and Dismemberment (AD&D). 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, speak with a Louisiana ERISA lawyer. He can help you understand your rights under your AD&D plan.
Life Insurance Claim Denials
If you have lost a loved one, you may be able to receive life insurance benefits funded by the company. However, a plan administrator may deny your life insurance claim if there is a dispute over:
- who is entitled to the insurance benefits,
- misrepresentation or nondisclosure, or
- eligibility under the Plan Document (benefits may be denied in cases of suicide or illegal drug use).
Just because the insurance company or plan administrator denies your initial claim, does not mean that your are not eligible for life insurance benefits. A skilled Georgia ERISA lawyer may be able to help you recover the benefits you deserve.
Bad Faith Insurance Claim Denials
At times, a plan administrator denies an insurance claim in bad faith. Insurance companies have a duty to evaluate your claim in a fair and neutral manner. In many states, if you have evidence of plan administrator misconduct, you may be able to collect punitive damages. Unfortunately, ERISA does not allow bad faith claims. Your lawyer can help you evaluate your claim, compile evidence showing bad faith by the insurance company, and maximize your compensation.
Speak to a Georgia ERISA Lawyer Today
If your disability claim was denied, you need an experienced Georgia ERISA lawyer by your side who can inform you of your options and help you file an appeal. Contact J. Price McNamara today for a review of your case.