In the video above, attorney Marc Whitehead explains why group disability insurance claims that have reached the Erisa disability claim litigation stage can be difficult to litigate in court.
If your insurance company denies your disability claim, there is a big difference in what you can do depending on whether your claim is under a group disability policy, or is a private disability policy.
The only way a group disability claim can reach the litigation stage is by exhausting the administrative appeal process. In other words, if the insurer denies your original application for benefits, you must seek approval by following the insurer’s appeal requirements.
You file an appeal with the insurance company. It is comprised of all of your arguments and evidence of disability. Think of this as the pre-litigation phase of your ERISA claim.
If you have done everything they demand and are still denied, then you may file a lawsuit in federal court to pursue benefits. But your case is still decided based on the administrative appeal.
The reason behind all of this is the law by which employer-sponsored group disability benefits are governed. That federal law is the Employee Retirement Income Securities Act or what’s known as ERISA.
How ERISA Disability Claim Litigation Works against You
Group disability plans are paid for, partially or completely, by your employer. The plan is not written for you (as a private disability plan would be) but instead is written to cover the general health of a group of people (company employees).
One of the original intents of ERISA was to provide “…a method for workers and beneficiaries to resolve disputes over benefits inexpensively and expeditiously.”
There is a lot of case law where this language is used (by the insurance companies) to uphold the view that Congress did not plan for claimants and payees to engage in lengthy, all-out trials in federal court, in order to obtain benefits.
Consequently, and to the benefit of the insurance company, ERISA procedure limits the scope of discovery, as the video above explains. Discovery refers to the abilities of the parties in the litigation to request information from the other side.
This means that the appeals stage of your claim is your last chance to enter new evidence. Remember, your case is decided based on the administrative record that occurred during administrative appeal.
As a general rule, no further medical evidence, vocational data or other proof of disability supporting your case may be entered during Erisa disability claim litigation.
So, the statement “…a method for workers and beneficiaries to resolve disputes over benefits inexpensively and expeditiously” became a convenient way for insurers to limit or refuse claimants the use of discovery to support their lawsuit. Historically, this version of ERISA statute that sparked this language was actually abandoned years ago; yet it still serves as basis for argument by insurance companies.
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Contact ERISA Disability Claim Litigation Attorneys
In ERISA-based claims – which make up the majority of long term disability insurance claims – many insurance companies try to withhold information as one of many ways to avoid paying benefits. The good news is, the courts are starting to realize the magnitude of the problem.
This is very good news for a disabled claimant, as it is a step in the right direction to level what a very harsh and unfair playing field is for disabled claimants.
Find out more about new ERISA disability regulations that will take effect in 2018!
To learn how we can help your obtain the justice you deserve, call our law firm today at (800) 562-9830 and speak to an experienced ERISA disability claims lawyer about the merits of your case.
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