When you apply for insurance benefits your employer provides, you may realize that they are not as easily to obtain as you may have believed. The Employee Retirement Security Act (ERISA), a federal statute, had the unintentional effect of creating challenges for employees trying to claim ERISA insurance benefits. A Savannah ERISA lawyer can help you increase your chances of successfully obtaining your insurance benefits by guiding you through the complex claim and appeal processes.
The purpose of enacting ERISA was to increase safeguards for employee pensions as well as employer-funded benefits, like:
The opposite occurred instead. ERISA’s rigid claims and procedures created many hurdles for disabled employees filing for insurance benefits while insurance companies, who determine the result of the insurance claims, were empowered.
ERISA is only applicable to insurance provided by your employer. State rules and laws oversee insurance plans not subject to ERISA. A Savannah ERISA lawyer can analyze your policy and help you throughout the ERISA or non-ERISA insurance claims procedure.
ERISA Disability Insurance Claims
ERISA mandates that your disability insurance plan’s claim and appeal procedures be in writing, usually in the Summary Plan Description (SPD) and Plan Document. Your employer or your plan administrator—who could be an insurance company, another third party, or your employer—must provide you a copy of these documents.
The Plan Documents is more detailed version of the SPD, which provides a summary of the following:
- Claim Procedures
- Disability Benefits
- Filing Deadlines
- Appeal Process
It is important to obtain a current copy of both these documents prior to filing a claim.
You will file the ERISA disability insurance claim with your plan administrator. You must adhere to the claims procedures and filing deadlines or you risk forfeiting your benefits. It would be a miscalculation to rely on the plan administrator, who decides the outcome, to perform a meticulous investigation since it is your responsibility to provide detailed and supporting evidence of your disability. Your Savannah ERISA lawyer can assist you in filing a comprehensive disability claim package to increase your opportunity for success.
Once approved, you will receive a written notice and your benefits. A written notice informing you your claim is denied will also explain why and how to appeal the decision.
Appeal a Denied ERISA Disability Claim
If you were denied ERISA disability benefits, you can appeal by:
- File an administrative appeal with your plan administrator
- Strictly follow the appeal procedures
- Submit any missing or additional supporting evidence
If your appeal is denied and you have “exhausted all of your administrative remedies,” you can then appeal to the Federal court. Your Savannah ERISA lawyer can help you throughout the appeal process.
ERISA Life Insurance Claims
If your loved one passed away, you may be entitled to his or her employer-funded life insurance benefits. You must follow the strict requirements. Often times, claims for life insurance are denied because of:
- Conflict over beneficiaries,
- Misrepresentation or nondisclosure, or
- Dispute regarding eligibility as defined in the Plan Document, e.g. ineligibility because the death was caused by illegal drug use or suicide.
Don’t worry if your initial claim is denied, which occurs often. An experienced Savannah ERISA lawyer can help you throughout the life insurance claim and appeal process.
ERISA Accidental Death and Dismemberment Insurance Claims
Employers may provide AD&D insurance benefits, but the employee’s severe injury or death must be caused by an accident rather than an illness or other “non-accident.” A knowledgeable Savannah ERISA lawyer can evaluate the facts and circumstances of the injury or death and help you determine the best course of action.
Non-ERISA Long Term Disability Insurance Claims
If you have an independent or private long term disability insurance (LTD) policy, it is not subject to ERISA because your employer does not provide it. However, you may still find it difficult to receive LTD benefits. Insurance companies frequently reject even valid LTD claims. Our LTD lawyer can review your policy and assess your eligibility upon an evaluation of your medical evidence that supports your inability to, depending on your policy’s definition of “disability,” perform your job or any job.
Bad Faith Insurance Claims
Unfortunately, insurance companies may have acted in bad faith when they failed in their duty to fairly and neutrally assess your claim when they denied your claim. If you have a valid bad faith claim, you may be entitled to compensation. If the underlying claim is not subject to ERISA, you may also receive punitive damages. We can assess your underlying insurance claim, as well as help determine whether you have a valid bad faith claim.
Retain a Savannah ERISA Lawyer
With a seasoned Savannah ERISA lawyer fighting for you, your chances of a successful ERISA or non-ERISA insurance claim for benefits increase substantially. Contact J. Price McNamara at 504-458-8455 for a free consultation.