Claiming benefits under the insurance policy provided by your employer can be frustrating and overwhelming — especially without an experienced Miami ERISA lawyer by your side. J. Price McNamara has to expertise to help you through the complicated insurance claim as well as appeal processes to obtain the benefits you deserve.
Employee Retirement Security Act (ERISA)
Federally enacted ERISA was supposed to provide protections for employee pensions and insurance — disability, life, and accidental death and dismemberment (AD&D) — benefits. But it backfired. Instead, employees pursuing ERISA insurance benefits faced challenges from the stringent claim and appeal procedures, while insurance companies that determine who receives the benefits were given more power.
Only insurance policies provided by your employer are subjected to ERISA. Both state and local rules apply to non-ERISA insurance policies. A Miami ERISA lawyer can review your insurance policy as well as help you obtain the benefits you deserve.
Disability Insurance Benefits
ERISA states that your employer or plan administrator — who could be a third party, like an insurance company, or your employer — must provide you, in writing, important information related to your disability insurance plan, such as:
- Claim Procedures
- Disability Benefits
- Filing Deadlines
- Appeal Process
Generally, the Summary Plan Descriptions summarizes this information while the Plan Document offers more detailed instructions and information.
To obtain disability benefits, you must first meet the filing deadlines and follow the claims procedures. You should ensure your claim package if complete before filing it with your plan administrator. Do not assume your plan administrator, who does not have any invested interest to ensure you receive benefits, will conduct a thorough investigation of your claim. Your meticulous Miami ERISA lawyer can help compile an effective and comprehensive claim package supporting your insurance claim.
A written notice of the outcome of your claim will be sent to you. If approved, you will receive your benefits soon after. If denied, the letter will explain the reasons for the rejection and provide instructions for an appeal.
You can appeal your denial by doing the following:
- Filing with your plan administrator an administrative appeal
- Strictly following the appeal instructions
- Submitting supplemental supportive evidence
You still have other remedies if the plan administrator denies your appeal. After exhausting “all of your administrative remedies,” you can file a new appeal in Federal court. Your Miami ERISA lawyer can package an effective appeal to increase your chances of success.
If your deceased loved one has life insurance through his or her employer, you may be able to receive benefits. These claims, however, are often denied because of the following:
- Issues over beneficiaries;
- Information was not disclosed or was misrepresented; or,
- Ineligibility — for example, your Plan Document may state that you are not eligible for benefits if the cause of death was suicide or illegal drug use.
A Miami ERISA lawyer can review your policy, assess your case, and craft your best strategy for benefits.
To qualify for AD&D benefits, the employee’s cause of death or severe injury must be from an accident, not a medical condition or other “non-accident.” A Miami ERISA lawyer can evaluate both the facts and circumstances of your injury or the employee’s death to recommend your best available options.
Even non-employer provided independent or private LTD insurance, which is not subject to ERISA, claims for benefits are often denied. Long term disability lawyer J. Price McNamara can review your LTD policy and subsequently determine your eligibility based on your medical evidence. Your supporting evidence must prove that, depending on your LTD policy’s definition of “disability,” you cannot work your job, or any job.
If the insurance company did not fairly and neutrally evaluate your denied insurance claim, as it has an obligation to do, you may be able to receive compensation. And if the underlying insurance claim is not an ERISA insurance policy, then you may also receive punitive damages—the award is to penalize the company for intentional and improper conduct. Bad faith insurance lawyer J. Price McNamara can review your underlying claim and help you file and litigate a bad faith claim.
A Knowledgeable Miami ERISA Lawyer Can Help
Whether you are seeking benefits under an ERISA or non-ERISA insurance policy, contact seasoned Miami ERISA lawyer J. Price McNamara at 866.278.8495 for a free consultation.