Applying for benefits under your employer-provided insurance policy is actually elaborate and convoluted — especially without the help of knowledgeable Jacksonville ERISA lawyer. J. Price McNamara has extensive experience to help you navigate the complexities of your insurance claim and appeal.
Employee Retirement Security Act (ERISA)
ERISA is a federal statute that was meant to provide additional protections for employee pensions and other benefits — like disability,life, and accidental death and dismemberment (AD&D) insurances. But it had the opposite effect. Instead, the strict claims and appeal procedures created obstacles for employees seeking ERISA insurance benefits, while empowering insurance companies who determine the outcome of the insurance claims.
ERISA only applies to employer-provided insurance policies. Non-ERISA policies are subject to both state and local rules. A Jacksonville ERISA lawyer can examine your insurance policy as well as guide you through the claims process.
ERISA requires that your employer or plan administrator — who could be your employer, an insurance company, or another third party — provide you, in writing, crucial information associated with your disability insurance plan, such as:
- Claim Procedures
- Disability Benefits
- Filing Deadlines
- Appeal Process
This vital information is usually summarized in the Summary Plan Description (SPD) and detailed in the Plan Document.
To obtain disability insurance benefits, you must abide by the filing deadlines and claims procedures or you may lose your benefits. When you file your claim with your plan administrator, it is important that your claim package is complete. Don’t presume your plan administrator will thoroughly investigate your claim; the administrator has no invested interest in you obtaining benefits. Your meticulous Jacksonville ERISA lawyer can help you compile a comprehensive claim package so you have a higher chance of success.
You will receive a written notice of approval or denial. If approved, you will receive benefits shortly thereafter. If denied, the letter will detail the appeal process and then explain why you were rejected.
You can appeal your denial by doing the following:
- Filing an administrative appeal with your plan administrator
- Adhering to the strict appeal procedures
- Submitting additional or missing supportive evidence
Don’t worry if the plan administrator denies your appeal. If you have “exhausted all of your administrative remedies,” you can file an appeal in Federal court. Your Jacksonville ERISA lawyer can educate you on your rights and help you throughout the appeal process.
Life Insurance Claims
You may be entitled to your deceased love-one’s life insurance benefits funded by his or her employer. It is important to understand reasons why life insurance benefits have been denied, i.e.:
- Controversy over beneficiaries
- Nondisclosure or misrepresentation
- Disagreement regarding the Plan Document’s definition of “eligibility” — for example, you may be ineligible if the death resulted from suicide or illegal drugs
Initial claims are often denied. So don’t worry, a Jacksonville ERISA lawyer can walk you through the life insurance claim and appeal process.
To qualify for AD&D benefits, the employee’s severe injury or death must be the result of an accident, not an illness or other “non-accident.” Jacksonville ERISA lawyer can examine both the facts and circumstances of the employee’s injury or death to determine your best strategy and course of action.
If you have an independent or private LTD insurance, which is not provided by your employer, you may still find obtaining LTD benefits challenging even though your LTD is not subject to ERISA. It is not uncommon for valid LTD claims to be rejected. Long term disability lawyer J. Price McNamara can examine your LTD policy and evaluate your eligibility based on your medical evidence. Depending on your LTD policy’s definition of “disability,” your evidence must support you inability to perform either your job or any job.
Bad Faith Insurance Claims
If the insurance company breached its duty to evaluate your claim fairly and neutrally when it denied you of your benefits, you may have a bad faith claim and be entitled to compensation. In addition, if the underlying insurance claim is not subject to ERISA, you may also receive punitive damages, which “punishes” the insurance company for its improper conduct. Bad faith lawyer J. Price McNamara can review your underlying claim and then determine whether you have a feasible bad faith claim.
Speak to a Jacksonville ERISA Lawyer
You can increase your chances of a successful ERISA or non-ERISA insurance claim or appeal for benefits by contacting Jacksonville ERISA lawyer J. Price McNamara. Call us 866.278.8495 today for a free consultation.