HAS YOUR ERISA LONG TERM DISABILITY INSURANCE CLAIM BEEN DENIED?
Here's the thing about ERISA governed long term disability insurance plans: they are usually going to be interpreted exactly as they are read. So you need to watch out for certain phrases that will make it very difficult to collect benefits should you ever actually need to use the policy.
Most people - yes, even lawyers, doctors and consultants - working in DC don't read through the long term disability policies they get as part of their employment benefits, and they make assumptions about what's in the policy. It's actually common sense, right? If your policy is called "long term disability," you wouldn't be crazy to assume that you are going to be covered in case you should ever have a disability that keeps you out of work long term.
I wish that it was that simple and reliable. But the reality is, many of the terms and conditions in the policy are actively working to exclude you from coverage, and the federal law that governs most of these policies (ERISA) makes it easy for the insurance companies to deny claims because they have "discretion." And though they should be looking out for your best interest (the premiums have been paid, after all) what they are most concerned about is their bottom line and reporting to their shareholders, who are also looking out for their bottom line.
It's not right. That's why, if your long term disability insurance claim has been denied, you should contact an attorney who understands ERISA who will know exactly what to do to give you your best chance at receiving benefits after an appeal. You should not try to handle an appeal on your own.
At this point you may be asking yourself: is having an ERISA long term disability insurance policy even worth it? The answer is, maybe, it depends on what's in your policy and the severity of the medical condition or injury you have. We like to advise people to buy supplemental insurance, just to cover all of their bases, with a non employee sponsored, non ERISA governed policy. But, if you already have a claim and need help getting benefits, you will want an attorney.
Here's what's great about having an attorney handle your ERISA claim:
1. An Attorney knows how to put together what's called an Administrative Record (this is your appeal of the denial of benefits - and should contain everything you need to convince the insurance company to put you back on claim) - it is also what the federal judge will rely on when deciding whether or not to award your benefits;
2. An Attorney will be able to help you navigate the medical community in order to get the proper documentation for your disability or illness. They will do this by working with your doctors or consulting physicians to review your case and making sure your medical records and reports give all of the proper information about your condition and how it affects your ability to work; and
3. An Attorney will know how to argue your case before a federal judge (there are rules of the courtroom, a level of proficiency that comes with experience, and a knowledge of what the judge needs to hear in order to rule on your case).
You need a lawyer in DC who will listen to you and work with you to put you in the best position to receive benefits from your claim. Long term disability appeals are a lot more than filling out a form and sending it in to the insurance company.
Give us a call today at 202-393-3320 and we will review your denial letter for free and give you our analysis on what to do next. Don't wait - if you received a denial letter, you only have 180 days to appeal under ERISA. That's not a lot of time given the amount of work you have in front of you.