Louisiana ERISA Lawyer
Many American workers are confident that if they sustain injuries and are unable to work, they will at least be able to depend on long-term disability benefits provided by their employers. That is, they are confident about it until they attempt to collect those benefits. Federal laws can make disability insurance claims difficult to navigate without assistance. If your medical conditions are disabling, you need a Louisiana ERISA lawyer who 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, and
- Accidental Death and Dismemberment Insurance.
Although ERISA was intended to provide increased protection to employees, you probably know by now that it has backfired. ERISA places countless hurdles to injured workers seeking to collect their disability benefits while empowering the insurance companies that approve or deny their claims. The insurance companies know that the law favors them, so they consequently have little incentive to approve claims.
If you are covered by an ERISA plan, you must follow specific claim procedures. However, not all insurance plans are covered by ERISA. If you have a personal disability insurance policy, state laws and rules apply. Furthermore, if you are a government or church employee, you may have a non-ERISA plan. A Louisiana ERISA lawyer can help you understand which laws and procedures apply to your claim.
How Are ERISA Claims Processed?
Under ERISA, your disability insurance plan must explain its claim and appeal procedures in writing. Before you file a disability insurance claim, 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, and
- 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 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, but 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. It is your responsibility to provide evidence supporting your claim and you should not rely solely on the plan administrator’s investigation. Your Louisiana ERISA lawyer can ensure that you fully develop your claim.
If the administrator approves your disability insurance claim, you will receive a written notice and 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 My ERISA Disability Claim Is Denied?
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 your administrative remedies, you can file a lawsuit in federal court. There are strict appeal deadlines and late appeals will be denied. Your Louisiana ERISA lawyer will ensure that you meet these requirements.
Long Term Disability Insurance Claim Denial
It can be devastating when your long term disability (LTD) benefits are denied. Unfortunately, insurance companies frequently deny valid LTD claims. If you have evidence that you cannot perform your job or all jobs (depending on your plan), you should file an appeal. A Louisiana 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, 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).
Do not assume that you are ineligible for life insurance benefits simply because the insurance company or plan administrator denies your initial claim. A skilled Louisiana ERISA lawyer 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, consider speaking with a lawyer. An experienced lawyer can help you understand your rights under your AD&D plan.
Bad Faith Insurance Claim Denials
Sometimes, a plan administrator denies an insurance claim in bad faith. Insurance companies have a duty to evaluate your claim fairly and neutrally. In many states, if you have evidence of plan administrator misconduct, you may be eligible for punitive damages. (Unfortunately, ERISA does not allow bad faith claims.) A skilled lawyer can help you evaluate your claim, as well as compile evidence showing bad faith by the insurance company and maximize your compensation.
Contact Louisiana ERISA Lawyer J. Price McNamara Today
If received a disability claim denial, you need a skilled Louisiana ERISA lawyer to help you file an appeal. Contact J. Price McNamara today for an initial consultation.