When you are denied long-term disability benefits under an ERISA-governed plan, you have the right to appeal that denial of benefits. Before you can file an appeal in court, however, you first must exhaust your administrative remedies. This means that you must go through the administrative appeals or review process that your insurance company provides. An insurance company may have one or two levels of administrative appeals. If you still receive a denial of benefits, you then can file an action in federal district court against the plan, the plan administrator, and/or the claims administrator.
By filing an appeal in court, you are asking the court to find that the insurance company wrongfully denied your claim for LTD benefits. The standard of review in ERISA-governed appeals differs from state to state and is primarily based on the language in the plan. In California, state law prevents plans from containing provisions that require courts to consider denials of benefits under an abuse of discretion standard. As a result, federal courts in California must consider appeals from the denial of LTD benefits “de novo,” which is a far more favorable standard for plaintiffs. This standard does not require courts to afford any discretion to the decision of the plan administrator in denying the claim for benefits.
Federal law does provide that claimants who win their appeals from the denial of long-term disability benefits in court may be entitled to attorney fees and interest. However, it is up to the court to decide whether to award these remedies to the claimants. Federal law does mandate a presumption in favor of a fee award for successful claimants in ERISA appeals, absent extenuating circumstances that would make such an award unjust.
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.