- Phone:
- 850-438-4899
- Fax:
- 850-438-4044
- Email:
- info@twwlawfirm.com
- Location:
- 1823 North 9th Avenue
Pensacola, FL 32503
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Disability Law
ERISA and Private Disability Insurance Claims
The Employee Retirement Income Security Act (ERISA) is a multifaceted, complex federal law that governs most employee benefits provided by private (non-governmental) employers. These employee benefits include group long-term disability insurance, life insurance, health insurance and retirement/pension plans. The basic goal of ERISA was the protection of promised benefits and to ensure that pension and welfare plans were managed responsibly. The sponsors of ERISA wanted to increase the transparency of plan management and ensure that employees would get the benefits that they were expecting. Unfortunately, since its enactment in 1974, ERISA has been interpreted by the courts in such a way as to reduce the legal protection available to policyholders.
ERISA gives the plan administrator – usually an insurance company – the power to decide if an individual qualifies for benefits. For example, if you file a claim for benefits under a group disability insurance policy/plan offered by your employer, the administrator will decide if you are disabled. If the administrator denies your claim, you must file an appeal with the administrator before you can file a lawsuit to obtain benefits. You have only a short time to appeal the denial (180 days from the date of the denial for disability claims). If you fail to timely appeal the denial, you will be forever barred from pursuing your disability or other benefit under any ERISA governed plan/policy. An ERISA disability appeal can be complicated and must include sufficient documentation that you are disabled as defined by the plan/policy. This is because ERISA usually prohibits the court from reviewing any evidence other than the insurance company’s file and those documents submitted with your appeal before the lawsuit was filed. To make matters worse, ERISA requires that the court uphold the plan administrator’s denial unless it has acted in an arbitrary and capricious manner. This is the case even if the court believes that you are disabled! This is why it is important to hire an attorney who specializes in ERISA before you file your appeal with the insurance company. This will help to assure that all possible evidence which supports your claim for benefits is submitted to the insurance company and will make a favorable decision much more likely.
It is important to know the terms of your employee benefit plan and insurance policies well before you ever have to file a claim for benefits. ERISA does not apply to Individual or private insurance policies that you purchase directly from an insurance agent. Nor does ERISA apply to employees benefits where the employer is a governmental entity or church. Rather, they are usually governed by the state law of the state in which the policy was issued. which is generally much more favorable to insurance policy holders. Under state law, a policyholder has the right to a jury trial and could receive damage awards in addition to the benefits due under the policy. A private policy may also provide you with better coverage or be less expensive. For these reasons, we encourage individuals to get quotes for private insurance coverage from an insurance agent or broker – NOT through your employer – and to compare that coverage and the cost of the policy with that offered by your employer.
We recognize that for most people, deciphering the complex language included in most insurance policies or plans is nearly impossible. If often appears as though insurance companies intentionally complicate insurance policies and the claim process so that they can deny coverage. Critical telephone conversations you have with the insurance companies are often carefully documented or recorded by claim examiners as potential evidence against you. Insurance companies also compile documents and hire their own doctors to give opinions that you are “not” disabled while ignoring your treating doctors’ opinions in order to “position” the claims file such that it will be slanted against you if an appeal or lawsuit is later filed.
Our firm is committed to ensuring insurance companies uphold their obligations. The attorneys at TWW know what needs to be done , when to do it and how to quickly maximize success in an ERISA or private disability claim. We make certain that your claim is properly documented and includes all of the medical and vocational information, statements of you and other witnesses as well as legal arguments. We will handle a case from the initial application for benefits through a denial, appeal and lawsuit, if necessary. Our success rate on ERISA claims and appeals is high because we invest the time and effort necessary to prove your claim early in the claims process and avoid future litigation.
Our law firm ensures that our clients understand the claim process, the risks of litigation, as well as the costs. We represent hard working people from a range of occupations at all income levels and suffering from many different disabling conditions. We understand how important your benefits are, regardless of your income level. We lay out a complete plan and work to bring the case to a conclusion as quickly as possible. If you want the best chance to obtain the benefits you deserve, contact TWW today. Let us dedicate the expertise of the Insurance Law Team to you.
