If you are denied long-term disability benefits, you have the right to at least one administrative appeal through your insurance company. Although it may seem somewhat futile to appeal your claim to the same insurance company that already denied it, exhausting your administrative remedies is required before you can further appeal your case. Once you have gone through the administrative appeals process unsuccessfully, you can file a lawsuit in federal court challenging the denial of your benefits.
ERISA is the federal law that governs most employer-sponsored LTD plans. Some exceptions to this general rule exist for government and church employees, in that state law governs those claims. Likewise, individuals who purchase their LTD policies independent of their employers generally must follow state law in appealing the denial of their benefits.
Under ERISA, the federal court is the exclusive means of reviewing a denial of LTD benefits in court. ERISA also limits the potential remedies that you can seek in a long-term disability benefits lawsuit. Under state law, claimants typically have more remedies available to them in an LTD claim that they do under ERISA.
If claimants successfully challenge the denial of their LTD claims in federal court, ERISA limits them to receiving the following remedies:
• Back benefits that should have been paid to claimants under the terms of their plans
• Prejudgment interests on the back benefits
• Attorney’s fees and costs
However, awards of prejudgment interest on the back benefits, attorney’s fees, and costs are not mandatory under ERISA. Additionally, for a plaintiff to successfully obtain an order for the defendant insurance company to pay attorney’s fees and expenses, they must prove “some degree of success on the merits.” Furthermore, even if the claimants are successful in their federal lawsuits, the federal court judge must remand or send the case back to the insurance company to determine eligibility for those benefits if the claimants want to receive future benefits.
Long-term disability claims are complex matters that require intensive knowledge of ERISA laws and regulations. As a result, you will need experienced legal representation and advice to pursue an ERISA-governed disability claim. Bonnici Law Group is a law firm focusing on ERISA long-term disability benefits and bicycle injury cases in San Diego, CA. When you need effective legal representation, contact Bonnici Law Group at 858-261-5454 or email us at firstname.lastname@example.org.