Disability Insurance Claim Denied? An ERISA Lawsuit Could Help

File an ERISA Lawsuit for Denied Benefits

Private disability insurance can be a significant source of value for employees and their families, and they expect to be able to rely on it in their times of need. But what happens when an employee’s disability insurance claim is denied?

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A comprehensive federal law known as the Employee Retirement Income Security Act of 1974, or ERISA¹, protects the interests of participants in many types of insurance plans. ERISA sets standards for the administration of benefit plans, including the proper procedure for appealing a denial of a claim for benefits. If the claims process set forth in your insurance plan proves unsuccessful, you may be able to file an ERISA claim appeal and/or lawsuit to assert your right to benefits under federal law.

Act Quickly After Disability Insurance Claim Denial

Private and Group long term disability insurance carriers and/or employer self-administered disability plans routinely deny claims in an effort to cut costs. This leads to a great number of claimants having their needs unmet, and it makes disability insurance claims a prime target of ERISA and non ERISA actions.

All insurance plans set criteria that must be met to qualify for benefits, and if your plan administrator decides you do not meet these requirements, your claim will be denied. But, an initial denial is not the final word on your right to benefits. Many complicated medical assessments can factor into your eligibility for private and/or group disability insurance benefits, and most policies or plans have internal rules for appealing claims that may have been wrongly denied.

Usually, failure to exhaust all of the internal appeal procedures within your insurance plan and/or failing to include expert reports and all of the other necessary documentation in the administrative record before heading to court is fatal to an ERISA claim. However, this does not mean you should wait to contact a disability insurance lawyer until after you have seen your claim through the full administrative review process.

On the contrary, it is imperative to get in touch with an attorney when initially filing a claim or as soon as your claim is denied. Not only can a Philadelphia ERISA disability lawyer employ the best strategies for getting a claim approved through internal processes, he or she also can help build the administrative record that will be critical for an ERISA appeal or lawsuit should your insurer continue to deny your claim.

The administrative record of communication between the claimant (you) and the plan administrator or insurance company is closed once the internal appeals process ends, meaning nothing more can be added to the record if you eventually decide to file an ERISA lawsuit, so it is important to make sure it contains all the relevant information or your lawsuit could be dismissed before it ever reaches a trial.

ERISA Damages

If your ERISA claim, appeal or lawsuit for disability benefits is successful, you may be entitled to back benefits and a lump-sum buyout of future benefits owed to that point or a declaration of your right to ongoing monthly benefits and, in some instances, compensation for your attorney’s fees. If your disability insurance claim has been denied or you are about to file a claim, do not make the mistake of waiting too long – contact a Philadelphia ERISA lawyer today. Call Edelstein Martin & Nelson, LLP at 215-731-9900. You may also contact our lawyers in Philadelphia online.

Employee Retirement Income Security Act of 1974, or ERISA¹ – https://en.wikipedia.org/wiki/Employee_Retirement_Income_Security_Act