The law firm of Marc Whitehead & Associates has helped sick and injured workers all over the U.S. obtain sorely needed disability benefits after their claims were initially denied by Sun Life and other insurance companies. ERISA and other laws give policyholders the right to appeal a right to appeal a decision to deny disability benefits.
For example, the disability lawyers at Marc Whitehead & Associates recently represented a 38 year old Texas resident who became severely disabled while covered under a long term disability insurance policy issued and administered by Sun Life.
Our client was formerly employed by M-I L.L.C., where she worked as a chemist. She was and currently is disabled due to severe pain in her lower back, hip, leg, left shoulder, and neck. She suffers from a pinched nerve in her neck, a bulging disc in her back, swelling in the brain, vision problems, light headedness and vertigo.
She was forced to sue Sun Life insurance company to secure all long term disability insurance benefits to which she was entitled under a disability insurance policy underwritten and administered by Sun Life after the insurance company denied her claim.
Social Security Approves Our Client’s Claim for Benefits; Sun Life Turns Her Down
The Social Security Administration had issued a fully favorable decision on our client’s claim for Social Security disability benefits under Title II and Title XVI of the Social Security Act, finding that our client’s physical impairments and their symptoms would have prevented her from performing any work activities on a consistent basis. Despite this, Sun Life denied our client’s claim for disability benefits.
Our client appealed the decision; on October 6, 2010, Sun Life notified her, affirming their original decision to deny Plaintiff’s claim for long term disability benefits, totally ignoring the findings of the Social Security Administration. She was also informed that she had exhausted all administrative remedies and that plan administrators would consider no further claims or evidence. In this last denial, Sun Life discounted the opinions of our client’s treating physicians and specialists as well as the documented limitations from which our client suffered, including the effects of her impairments on her ability to engage in work activities.
Since our client was told she had exhausted all available administrative remedies, there was nothing left to do except file a lawsuit in federal court to obtain the disability benefits to which our client is rightfully owned. We knew that if our client got the fair hearing she deserved, Sun Life’s decision to deny benefits would be overturned.
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Venue & Jurisdiction of Long Term Disability Lawsuit
Our client’s lawsuit named Sun Life Assurance Company of Texas, an insurance company based in Dallas, Texas, as the Defendant. Her suit was filed in a federal court in Texas pursuant to 28 U.S.C. § 1331 (“The district courts shall have original jurisdiction of all civil actions arising under the Constitution, laws, or treaties of the United States”) to our client’s rights under the ERISA, as allowed by 29 U.S.C. §§ 1132, 1133, & 1140.
The Law – The Employee Retirement Income Securities Act (ERISA)
This claim was allowed under federal ERISA law.
Our client’s policy, like almost all long term disability plans offered by a private employer, is governed by the Employee Retirement Income Security Act of 1974, or ERISA. It’s a federal law that regulates the handling of Employee Benefit Plans and the remedies of the beneficiaries of these Plans.
ERISA applies to all employees benefit plans established or maintained by an employer engaged in commerce or by an employee organization representing employees engaged in commerce. Practically all long term disability plans offered by a private employer are governed by ERISA.
Among other things, ERISA provides policyholders with the right to file a lawsuit in Federal Court to appeal a denial of benefits by an insurance company. However, a claimant challenging a disability denial under an ERISA governed plan or policy must bring the claim pursuant to ERISA regulations and procedures.
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Get the Legal Help You Need to Get the Disability Benefits You Deserve
Disability insurance claims are governed by a complex set of laws and procedures. A lot of people make the mistake of assuming they can handle an administrative appeal on their own, choosing to reserve the option of hiring a lawyer as a last resort. Don’t let this happen to you. Insurance companies like Sun Life use ERISA’s rules and regulations to their advantage, making it difficult for a disabled worker to receive benefits or to keep them after a certain period of time.
You only have a limited time in which to appeal and this will be your only chance to submit evidence into the record. The sooner you hire an experienced disability appeal lawyer to represent your interests, the better your chances of having your claim approved on appeal.
Marc Whitehead & Associates has an outstanding track record when it comes to overturning the unfair denial of disability benefits by Sun Life and other insurance companies during the appeals process. If you believe your claim for disability benefits was wrongfully denied, contact Marc Whitehead & Associates at 800-562-9830 to schedule a free consultation with one of our LTD Disability Denial Lawyers.
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