Resolving Your Group Disability Claim
Today’s video outlines the possible outcomes of a disability case under ERISA law. Resolving your group disability claim may encompass any of the following:
- Reaching a Settlement: Your insurance provider agrees to settle the case for a “settled on” amount of money.
- Moving for a Motion for Summary Judgment: You request the judge to decide your case without litigation.
- Proceeding to a Bench Trial: A federal ERISA judge reviews your case and makes a decision based on the existing administrative record. There is no jury, and you do not personally attend “trial.”
- Going Back for a New Administrative Appeal: A judge may find that the case is lacking sufficient evidence. If so, the judge may send the case back to the administrative appeal level. You (and the insurance company) would now have “new” time to develop your case further, prior to a final decision.
Most group LTD claims are denied either initially or on appeal. Does resolving your group disability claim mean you’re destined to appeal your claim or file suit? There is a better way!
How to be sure your claim is as strong as possible from the start.
With the help of the disability benefits lawyers at Marc Whitehead & Associates, you have a better chance of having your initial claim application approved. Our law firm will take care of every detail. We also offer this checklist for long term disability claim applications.
- Claim forms are notoriously vague and misleading. Not all disability lawyers will help you file your initial application. Contact one that will.
- Get a copy of your disability policy, or the policy’s Summary Plan Description (SPD) which gives an overview of the plan and your obligations in filing a claim. You need to have a very good understanding of
- Write down and schedule all dates and deadlines stated in your policy.
- Respond in a timely manner to all requests by your insurer for financial, medical or vocational information. Be accurate and factual in your responses.
- Have access to all of your relevant and current medical records and physician reports. Maintain a good rapport with your treating doctors.
- Know your policy’s definitions of disability, other definitions and terms, and requirements regarding medical information. Examine how your medical records equate with what is revealed in the Summary Plan Description or policy.
- Your initial application is the beginning of your claim file. You want to develop your claim file thoroughly. “Stack the record” with evidence of your medical records, doctors opinions and reports, your actual occupational duties, vocational evidence of disability, testimony of how your impairment(s) affect your daily life, technical data supportive of your condition and other valid proof of disability.
- Apply for Social Security Disability Insurance benefits.
- Keep in mind that, once you file a claim, you may be survived by video and monitored through Social Media.
- Document all correspondence you have with your insurance carrier.
Without experienced legal counsel by your side, submitting a sufficient claim is a tough task. Our law firm offers complete long term disability application and filing services for both individual and group disability claims.
Resolving Your Group Disability Claim after the Appeal Process
What if you are at the point in your case where the administrative appeal has been finally denied? Your best bet is to immediately consult an experienced ERISA attorney. Here are a few things to know.
When Does My Lawsuit Begin?
After the insurer notifies you that your appeal is finally denied, you may file an ERISA lawsuit. This means you have submitted the administrative appeal, and all administrative remedies during the appeal process have been exhausted. The deadline for filing a lawsuit is spelled out in each insurance plan or policy.
Who Do I Sue?
In an ERISA disability claim, in most cases you are suing the insurance carrier. This is because the insurer is typically the entity that funds the benefits and also makes the determination of whether you will receive benefits or not. However, there are some exceptions. You may have a case where the employer funds the benefits or plays a role in making the claim determination. In other cases, a third party administrator may be responsible for deciding whether you are disabled.
How Does a Settlement Fit In?
Some jurisdictions call for mediation meetings or settlement talks in all cases. Other jurisdictions allow each case to make its own call regarding the settlement process.
Your attorney will initiate a settlement by making a demand for an amount that is based on your claim’s value and merits. Settlement negotiations are generally informal discussions where both sides make offers and counter offers, in support of their case.
Mediation is a more formal process involving a neutral third party whose purpose is not to make a decision, but to help facilitate a settlement.
Read more about understanding ERISA settlements and court awards.
If Your Case Goes to a Bench Trial
Up to now, you have been trying to prove you are disabled. Now, at the trial and litigation stage, you are trying to show that the insurance company unfairly and unreasonably denied your claim.
This fact underscores the real need for all prior documentation and proof of disability that you built into your claim file. Because with this caliber of information, the judge can deduce whether an insurer is being unreasonable in their decision to deny.
An experienced ERISA lawyer will know the information needed to prove you are disabled on appeal and at trial.
Resolving Your Group Disability Claim is What We Do
Our personal attention is provided to each and every client. If you are considering applying for LTD benefits, or you have filed your claim and the insurance company sent you a denial letter, get in touch with us as soon as possible to understand your options and how we may help.
View resolved cases in which our attorneys have fought for and won the approval of denied long term disability benefits for our clients.