Many American workers believe that if they cannot work due to injuries, they can rely on their employer-provided long-term disability benefits. However, you can often run into issues once you attempt to collect these benefits. Without legal assistance, Federal laws make it difficult to navigate disability insurance claims. A San Antonio ERISA lawyer can help you understand your rights.
What is ERISA?
Federal law Employee Retirement Income Security Act (ERISA) protects employee pensions and other employee-funded benefits such as:
- Life Insurance
- Disability Insurance
- Accidental Death and Dismemberment Insurance
Although intended to provide employees increased protections, ERISA had the opposite effect: injured employees seeking to obtain disability benefits faced countless obstacles while insurance companies approving or denying their claims were empowered.
If you are covered by an ERISA plan, you must follow specific claim procedures. Many insurance plans are not non-ERISA, however, such as government or church employees. Additionally, state laws apply to personal disability insurance policies. Because of these complications, a San Antonio ERISA lawyer can best help you comprehend the laws and procedures applicable to your claim.
Processing ERISA Claims
Pursuant to ERISA, your employer-provided disability insurance plan must explain, in writing, its claim and appeal procedures. Be sure to request a copy of your current Summary Plan Description (SPD) and Plan Document, which your employer or plan administrator must provide, before attempting to file a disability insurance claim. An SPD provides you with an overview of:
- Claim Procedures
- Disability Benefits
- Filing Deadlines
- Appeal Process
You must strictly adhere to the claim procedures and filing deadlines outlined in your SPD and Plan Document, or you risk losing your disability benefits. Your plan administrator – who may be an insurance company, your employer, or a third party – has the power to approve or deny your claim.
Your filed ERISA claim submitted to the plan administrator should contain detailed information and evidence, like medical records. Do not solely rely on the plan administrator’s investigation. It is your responsibility to provide all supporting evidence of your claim. Your San Antonio ERISA lawyer can help you compile evidence to fully develop your claim.
You will receive a written notice if your disability insurance claim is approved, and can begin receiving benefits shortly thereafter. If denied, you will receive a letter explaining the reasons for the denial as well as information on the appeal process.
Denied ERISA Disability Claim
If your ERISA disability claim was denied, you can appeal the decision. Before filing a lawsuit against an ERISA plan, you must first “exhaust your administrative remedies” by:
- Filing an administrative appeal with your plan administrator;
- Adhering to the appeal procedures set out in your SPD; and
- Submitting any additional or missing evidence prior to your plan administrator issuing a decision on your appeal.
If your appeal is denied and you have exhausted all your administrative remedies, you may then file a lawsuit in federal court. The appeal deadlines are strict and any late appeals will be denied. Your San Antonio ERISA lawyer will ensure you meet all requirements.
Denied Long Term Disability Insurance Claim
Denial of your long term disability insurance (LTD) benefits can be devastating. Unfortunately, valid LTD claims are still frequently denied. You should file an appeal if you have evidence that you cannot perform your job, or – depending on your insurance plan – any job. A San Antonio ERISA lawyer is available to guide you so you may understand your plan’s eligibility criteria, the strength of your medical evidence, and the appeal process (if applicable). Having a personalized strategy may become the difference between a denial and obtaining the benefits you deserve.
Denied Life Insurance Claim
You may be able to receive employer-funded life insurance benefits if you have lost a loved one. The plan administrator may deny your life insurance claim if there is a:
- Dispute over who is entitled to the benefits,
- Misrepresentation or nondisclosure, or
- Issue of eligibility under the Plan Document (for example, denied benefits due to suicide or illegal drug use).
Denial of your initial claim does not mean ineligibility of life insurance benefits. A skilled San Antonio ERISA lawyer can help recover the life insurance benefits you deserve.
Denied Accidental Death and Dismemberment Insurance Claim
Employers frequently provide employees with Accidental Death and Dismemberment (AD&D) insurance. AD&D pays benefits if an employee is killed or severely injured due to an accident, as opposed to an illness or “non-accident.” An experienced lawyer can help you understand your rights under your AD&D plan.
Denied Bad Faith Insurance Claim
Insurance companies are required to evaluate your claim neutrally and fairly. If they don’t, then they could be acting in bad faith. Many states permit punitive damages if the insurance company acted in bad faith. ERISA, however, does not permit bad faith claims. An experienced attorney can evaluate and investigate your bad faith claim; and, maximize your compensation.
Seek a San Antonio ERISA Lawyer
A seasoned San Antonio ERISA lawyer can help you file your disability insurance claim or appeal. Call J. Price McNamara today.