ERISA governs most long-term disability insurance policies that you purchase or receive through your employer. As a result, administrative and court appeals of the denial of disability benefits are subject to various rules and procedures. These rules tend to be very strict and place significant limitations on individuals who are seeking disability benefits.
Many individuals who apply for long-term disability benefits receive a denial of benefits. They then have the requirement to appeal the denial administratively through the insurance company prior to filing a lawsuit. Once claimants have exhausted their administrative remedies, they can petition a federal court for review of their cases. However, federal court review is minimal, and some limitations apply to the claimant’s ability to conduct discovery in these proceedings.
Discovery consists of various methods designed to help individuals obtain information from other parties that may be helpful to their claims. Some common examples of discovery techniques include depositions, in which lawyers ask parties questions related to the pending claim, and requests for production of documents, which is a written request for specific materials. Historically, ERISA disallowed discovery in federal court cases that involved the denial of long-term disability benefits.
Now, however, discovery is allowable when the insurance company acts as both payor and claims administrator, which is a conflict of interest. Since the insurance company is the payor, its interest is in denying claims and saving money. On the other hand, claims administrators are supposed to process and approve valid claims. When the same company performs both functions, their interests may be competing.
As a result, courts have allowed depositions and written discovery to proceed in federal court cases concerning the denial of long-term disability benefits. For instance, claimants can conduct discovery concerning the qualifications of and compensation for in-house medical personnel, the quality control standards of the administrator, and the opinions of independent physicians who have reviewed the case.
It can benefit you greatly to get legal advice about the most effective means of building and maintaining the most successful ERISA long-term disability claim possible. Bonnici Law Group provides skilled, aggressive legal representation regularly for individuals who are seeking long-term disability benefits under insurance policies governed by ERISA. Our priority is to represent your interests and protect your rights to the benefits that you deserve. Call us at 619-259-5199 and schedule an appointment to meet with us about your case today.