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The ERISA disability claims process is a procedure for employees seeking disability benefits through their employer-provided insurance plans. Managing this process involves several key steps, from understanding your policy and filing a claim to handling potential denials and appeals. Knowing what to expect can help you track the benefits you should receive under the Employee …
Before you can appeal an ERISA long-term disability denial, you must exhaust all of your administrative appeals. That means you must file an administrative appeal with your insurance company before you can pursue a court case. If your denial is upheld on appeal, you can then proceed with a lawsuit. Gather evidence in support of …
The federal ERISA statute is filled with technicalities, hidden pitfalls and land mines — so much so, the unrepresented claimant has little chance of successfully fighting a wrongful denial of benefits. Group disability insurance claims can be successfully handled when an experienced ERISA lawyer is in your corner fighting for you. Our law firm is …
ERISA is a federal law that regulates the handling of Employee Benefit Plans. The term is an acronym for the Employee Retirement Income Security Act of 1974. By definition, ERISA covers practically all group disability, health, and retirement plans within private industry. Without a doubt, ERISA is a hot button issue in disability insurance law. …
The topic of today’s video is ERISA preemption. ERISA stands for the Employee Retirement Income Security Act of 1974. It is the federal law that governs most group long term disability claims.
To preempt means to displace something. ERISA preemption means that in a dispute over a group disability claim, federal ERISA law displaces state law and commandeers the entire process. All state laws (that otherwise would play a role in insurance disputes) become void in an ERISA disability case.
There are times when a court may award attorney fees in ERISA disability cases. If your group disability claim enters into the litigation phase after the administrative appeal has been. exhausted, you have the right petition the court to have the other side pay attorney fees. But there’s a catch.
To put it bluntly, ERISA plans favor the insurance companies quite a bit in a number of ways. One of the prominent examples of this is the fact that you are not allowed to file any state law claims against the insurer for engaging in bad business practices with you during your time with them.
What does that really mean, though? How much does it matter in the grand scheme of things? Hopefully it won’t matter at all for you in your disability insurance claim, but the blanket refusal of state law claims forbids you from going after your insurance company for a number of potential issues.
Another way that the ERISA law actually favors insurance companies over individual policyholders is in the fact that your “remedies are limited” if you ever have any problems with your insurer on your disability claim.
Basically, what it means in layman’s terms is that when your insurance comes through your employer, there’s not much that you can do to punish your insurance company if they treat you poorly or otherwise violate the terms of your policy or even the law. Someone who buys their own policy on the free market, for example, could then take their insurer to court if they believe they were abused in some way and sue them for all the damages they were sustained because of the wrongful denial of benefits.
If you’re fighting a denial on an ERISA law disability claim, there’s a pretty good chance that your insurers have used terminology such as your “skill level” without actually explaining what it means.
Generally speaking, jobs are broken down into three skill level groups: unskilled or semi-skilled, skilled, and very skilled. These jobs are then further categorized by numbers ranging from 1 to 9. Jobs in the 1-3 range are considered “unskilled” or “semi-skilled.” Those that fall between 4 and 6 are called “skilled,” and “very skilled” jobs rate between 7 and 9.
Some clauses in a long term disability insurance policy can actually favor the claimant. Some policies have a Salary Percentage Requirement included in the any occupation definition of disability. This provision in the policy is the requirement that your insurance company can’t just say that you qualify for any job at any wage and deny you disability benefits based off of that. In most cases that percentage has to be 60-80 percent or more of the income that you were earning in your previous position.
For example, let’s say that a registered nurse was making $70,000 a year and started suffering from a disability that prevented her from continuing in the position. The insurance company would not be able to take her lower-level office and administration skills and say that she doesn’t deserve benefits because she can just go get a receptionist position for $24,000 a year because that’s way less than 80 percent. Naturally, though, it’s not quite that straightforward.
