Long Term Disability Insurance
Denials are commonplace.
Let Bonnici Law Group be your voice.
Group insurance can either be short or long term disability insurance provided by, or purchased through, an employer. A significant percentage of disability coverage is provided by employers to cover their employees. When an employee is a covered beneficiary of a group insurance policy, purchased by an employer, any claim for benefits pursuant to the policy is governed by ERISA (the Employee Retirement Income Security Act (ERISA)).
ERISA is a comprehensive and complicated law originally enacted to protect employees’ rights to their benefits. However, that is not the case anymore. It is now widely accepted that ERISA protects and favors insurers, and not disabled claimants. Here are some reasons why:
The ERISA claims process is complicated – ERISA has strictly enforced rules, requirements, and time deadlines that are well known by insurance companies but not by most disabled claimants. A denied claimant has only 180 days to appeal a denied claim, and insurers have up to 90 days to consider the appeal. Before any federal lawsuit can be filed, a denied claimant must “exhaust administrative remedies” by appealing in writing to the denying insurance carrier. During the entire time, the disabled claimant is without income from his or her job.
Evidence to Support Disability – Since appeals are based upon medical evidence in the claims file, it is crucial that the claimant’s file is stacked with compelling medical evidence; which both support the disability and refute the insurance carrier’s basis for denying the claim. ERISA provides insurers wide discretion to administer their own policies and to determine a disabled claimant’s eligibility for benefits under the policy. It is often very difficult – without experienced legal counsel – to prove that the insurance company wrongfully denied your claim and “abused that discretion”.
SSDI – This can be a “Catch 22”. Most ERISA disability policies require a disabled claimant to apply for Social Security Disability Insurance (SSDI) benefits. If a disabled claimant is awarded SSDI benefits, the insurance carrier usually is able to offset the claimant’s monthly SSDI benefit from any amount it may owe the claimant. Under ERISA, the insurer is not compelled to pay benefits just because a disabled claimant was awarded SSDI benefits. Conversely, if a disabled claimant is denied SSDI benefits, the insurer may use that against the disabled claimant.
Lawsuit in Federal Court – If your case is denied, after the internal appeal process, then a suit in the US District Court is the final option. Suits filed under ERISA and are cases are decided by judges, not a jury. Cases are decided based on briefings of attorneys who argue based on the evidence provided in the claims file—that is why having a complete claims file, built by a knowledgeable attorney before filing suit, is so crucial.
Unfair Process – In reality, few disabled persons have the time, energy, or resources to put up a fight against a strong, well versed insurance company. Insurers know this. Bonnici Law Group takes viable long term disability cases on a contingency basis. This means, if we’re not successful, you don’t pay.
The Need for Experienced, Skilled Counsel to Fight a Denied ERISA Disability Claim
It cannot be overstated that a claimant who has been turned down for disability benefits, or alternatively whose disability benefits have been terminated, will require competent counsel, well versed in ERISA litigation. It is virtually impossible and certainly impractical for a disabled claimant to even attempt to singularly traverse through the virtually endless maze of an insurance company’s “claim’s team” (i.e., the “Claim Specialist,”, the “Appeal Specialist,”, the “In-house Nurse,” the “Peer-Review physician,” the “Vocational Specialist,” and the “Surveillance Specialist”).
Contact Bonnici Law Group today for your FREE claim evaluation. Let us help you fight for your rights.