In ERISA disability lawsuits, the insurance company (defendant) will not face a jury. In fact, as the video explains, if your claim continues to be denied on appeal and your case goes to Court, in most cases you will not be entitled to a trial at all.
No jury will be able to hear your live testimony, or your doctor’s confirmation of your disabling condition, or a vocational expert’s validation of your inability to perform any occupation.
ERISA disability lawsuits are never argued in front of a jury. Instead, “employee benefit claims” are paper reviews, adjudicated by one federal judge who in all likelihood will never see you and will not be swayed by the emotion of your case.
The judge will review the administrative record only: the same case file, facts, records, and details that the insurance company denied on appeal. Those details are what many insurers work so hard to manipulate in order to deny claims.
ERISA Disability Lawsuits – What Is “Enough” Information?
The insurance company hopes that the information you submit in your claim, or on appeal, will be nothing more than a summation of your condition. They are betting that your claim or appeal is not airtight to the extent that a judge would find in favor of your claim, and overturn the denial in court.
Most of all, the insurer hopes you do not hire an experienced lawyer.
What should you include on your initial application for LTD insurance benefits? While one case is distinctly different from the next, here are the essentials:
- complete medical records
- treating physician’s opinions
- expert medical reports
- evidence proving pain
- evidence proving cognitive impairments
- proving the economics of your claim
- employer’s statements
- affidavits from friends, witness and co-workers
- job description describing all that you really do
- descriptive account of your disability and how it affects your daily life
- vocational evidence of disability as it applies to the demands of your job
- assessment by a vocational expert
- evidential photographs
- pertinent technical articles
If the initial claim is denied, your next step is to appeal the denial. In the appeal you will need to develop your case to argue every point in the insurance company’s denial letter. In this way, you will be setting up your case for judicial review.
Why Are ERISA Disability Lawsuits So Restrictive?
ERISA is the acronym for Employee Retirement Income Security Act of 1974. It is a federal law, and as its name suggests, it controls employee retirement and pension plans.
What surprises many people is that ERISA also controls most other employee benefit plans including:
- Long-Term and Short-Term Disability Insurance Plans
- Life Insurance Plans
- Accidental Death & Dismemberment Insurance
- Health Insurance Plans
The shared quality is, these plans are all sponsored by employers. ERISA law was meant to protect retirement plans from fraud and mismanagement. To do this, Federal ERISA law preempts all state laws regarding insurance and contract laws.
Consequently for group disability insurance plans, ERISA deprives you of much-needed protections provided by state laws. This has been a complex, ongoing argument for decades. As of 2018, there has been some breakthrough with new ERISA regulations as far as a disabled claimant’s rights.
Ask Us about Your Disability Claim Today: 1-800-562-9830
If you were denied long term disability benefits we are prepared to help you now. We effectively assist claimants in many ways that other firms do not. See how we make it as easy as possible for our clients, through experienced and attentive representation.