Will I Need to File a Lawsuit?
Written by Stephen Fields on March 6, 2016
When you first apply for long-term disability benefits, the insurance company chooses to either accept or deny your case. If your long-term disability claim was denied, you usually have the option to request an administrative appeal where the insurance company conducts a review of your claim.
At this stage, your claim will again be accepted or denied. If denied, you can then pursue a lawsuit against your insurance company. The lawsuit will be filed in Federal District Court and will be governed by ERISA law.
Most people are surprised when their long-term disability benefits claims are denied, and may even lose hope after submitting an appeal only to have the disability insurance company uphold their decision to deny or stop paying benefits. The only glimmer of hope is a small paragraph at the end of the insurance company’s denial letter saying you have the right to file a lawsuit in federal court under ERISA Section 502(a) if you filed an appeal and your request for benefits was denied.
What is ERISA?
ERISA stands for the Employee Retirement Income Security Act of 1974. Its a federal law that was enacted to set minimum standards for employer sponsored pension and health care plans. The Act was designed to protect individuals’ retirement and income rights.
Most long-term disability policies are governed by ERISA law. Typically, group policies provided by employers qualify under ERISA while individual policies are governed under State Laws.
Does A Lawsuit Need To Be Filed In Order to Get Benefits Approved?
It’s not uncommon for long-term disability claims to make it to this stage. In fact, the majority of long-term disability claims Fields Disability handles require a lawsuit. Our team of attorneys knows how to smoothly transition to this phase, and moreover how to obtain the fastest possible resolution. After all, we know you need to replace the income you lost when you had to stop working due to your disability.
If your claim reaches the lawsuit stage, the experienced lawyers at Fields Disability also know how to get the best possible results. Less experienced long-term disability attorneys may not understand certain nuances of the legal landscape that can affect your lawsuit.
No matter what, the long-term disability attorneys at Fields Disability understand the subtleties of the complex law that governs law long-term disability lawsuits, and know how to make the law work in your favor whenever possible.
The attorneys at Fields Disability also know how to get the maximum amount from your insurance company. We will seek every single dollar you may be entitled to, from benefits, to penalties your plan may owe you, a refund of premiums you shouldn’t have paid after you became disabled, or even forgiveness of an overpayment debt.
We have the knowledge and experience you need to give you the best possible results. Contact Fields Disability today. We’re available 24/7 to help you get the long-term disability benefits you paid for.
It’s Important To Get An Attorney As Soon As Possible
It is important to seek help as quickly as possible because there are time restraints on when a lawsuit against the insurance company may be filed. If you wait too long to file a lawsuit, your claim may be barred.
If you attempt to file a lawsuit against the plan administrator pro-se (on your own behalf), you may miss certain key issues and errors made by the plan administrator, and may not have another chance at bringing another claim.
Additionally, it is important to know that even before you file a lawsuit, your claim may already be in danger of getting denied. This is because the courts typically only review whether errors in your case were made by the plan administrator, rather than whether you are actually injured, disabled or eligible for benefits.
This is a critical step in the process and it is imperative to have an attorney help you strengthen your case before an administrative appeal decision is issued and far before a lawsuit is filed.
An attorney will not only walk you through why the insurance plan administrator denied you, but will also guide you through what is needed from your treatment providers to give you the best possible chance of obtaining your long-term disability benefits.