Long Term Disability Insurance claims can be difficult to pursue in an administrative appeal or in federal court. One of the difficulties for claimants to overcome is the restrictive rules that have evolved from the common law governing the Employee Retirement Income Securities Act (ERISA). ERISA applies to most disability insurance claims.
Claimants must prove the insurance company “Abused its Discretion”
In a disability insurance claim brought under state law, the disabled claimant only has to prove it is “more likely than not” that they are disabled. This generally only applies to individually purchased policies. Most policies however are obtained through a worker’s “Employee Benefit Plan.” Employee Benefit Plans are usually governed under ERISA. In most claims brought under ERISA, the claimant must prove that the insurance carrier “Abused its Discretion” when it denied your claim. This is a very tough standard requiring you to show the insurance company had “No Reasonable Basis” for denying your claim. An example might be if you had three doctors that said you were disabled and the insurance company only had one that said you were not. The insurance company could legally argue that they had a “reasonable basis” to deny your claim based on their one doctor, in spite of your three.
For a free legal consultation, call 800-562-9830
Disability Insurance companies such as Unum, Cigna, Aetna and Prudential often write their policies so to take full advantage of ERISA rules and regulations to make it difficult for a disabled person to get receive benefits or to keep them for the entire length of the term of their insurance policy. Other insurance companies with a large share of the disability market include The Hartford, Standard Insurance, SunLife, MetLife and Liberty Mutual, Provident, CNA, John Hancock, Colonial, AXA Equitable, New York Life, Guardian, Penn Mutual.
If you have questions, ask disability attorney, Marc Whitehead by visiting disabilitydenials.com or you can download Marc Whitehead’s free E-book, Disability Insurance Policies-How to Unravel the Mystery and Prove Your Claim.
Call or text 800-562-9830 or complete a Free Case Evaluation form
