When workers apply for long-term disability benefits under their employer-sponsored LTD plans, the Employee Retirement Income Security Act or ERISA governs the application process, as well as their rights to benefits. In all too many cases, however, insurance plan administrators deny their claims for benefits. Under ERISA, a denial of benefits does trigger some basic rights for claimants. However, equally as significant are those rights that ERISA does NOT entitle claimants, which can be highly damaging to their ability to obtain LTD benefits coverage under these plans.
When individuals receive a denial of benefits, they do have the right to appeal that denial. However, ERISA sets forth strict procedures and deadlines for doing so. Failure to follow these procedures and deadlines can result in you being ineligible for long-term disability benefits. For instance, individuals must exhaust their administrative remedies with the insurance plan administrator before they can file a lawsuit in federal court challenging the denial of benefits. This means that they must appeal the denial of benefits directly to the plan administrator first before they can seek relief in court. Some plans even provide for two levels of administrative appeals that claimants must complete before they resort to filing a lawsuit in court.
Furthermore, once claimants who have been denied LTD benefits are eligible to file a lawsuit in federal court challenging the denial, they are not entitled to a jury trial. They also are not generally allowed to conduct any discovery. Instead, the federal judge typically conducts a review of the existing record, using a standard of review that usually is very deferential to the decision of the insured. Claimants cannot present any new evidence to support their claims, either. These limitations can make it significantly more challenging for claimants to obtain a good result on appeal.
If you need to apply for long-term disability benefits, you may greatly benefit from calling us today and getting the advice that you need. Bonnici Law Group has the experience and knowledge that is invaluable when applying and qualifying for long-term disability benefits. When you need answers, contact Bonnici Law Group today at 619-259-5199. As we focus our efforts on long-term disability claims, we know how to protect your rights and build a strong demand for compensation in your case.