If your insurance policy comes through your employer, and your claim has been denied, your case falls under the federal ERISA code (The Employee Retirement Income Security Act of 1974). Ironically, this act was passed to protect the cash in your pension fund, but over time it has been used to protect insurance companies more than employees. And for some reason it covers employer-sponsored disability insurance plans in addition to dealing with pensions.
Ninety-nine percent of all disability insurance plans offered to employees are governed by ERISA. Under ERISA, you have the right to file suit in federal court if your claim for benefits is denied.
But, unlike almost any other legal proceeding, one side goes into court with all of the “good cards.” That side is the insurance company.
The most important card held by the insurance companies is something called a “reservation of discretion.” The reservation of discretion is something that the courts have given to the insurance companies – free! Here is what this “special card” means:
If your claim for benefits is denied, you will lose your lawsuit against the insurance company, even if you are right and it is wrong, if there is any evidence that supports the insurance company’s decision.
In any other legal proceeding, you can win if you have more than 50 percent of the evidence in your favor. Under ERISA, however, the claimant can have 85 percent of the evidence, and the insurance company can have 15 percent of the evidence, and if the insurance policy contains a “reservation of discretion,” they win!
If your claim has been denied, you'll need an experienced attorney to review your denial letter. We will review your denial letter for free. Contact my legal team at 202-393-3320 to take advantage of this incredible offer.