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Long-term disability (LTD) insurance is a crucial safety net for many employees. These benefits provide financial security for a disabling illness or injury. While many employers offer LTD coverage as part of their benefits package, the claims process can often be complicated and frustrating, and many claims are denied.
Why? Unlike Social Security disability adjudicators, long-term disability adjusters are financially incentivized to deny your claim. Long-term disability companies are private companies with big profit margins, and the more claims they approve, the less profit the company makes.
Have your ERISA benefits been denied or terminated? It is time to consider using a long-term disability attorney. ERISA attorneys are pivotal in helping claimants navigate this complex legal landscape. This blog post will discuss how ERISA attorneys help with long-term disability claims. You can also call Ortiz Law Firm at (888) 321-8131 to schedule your free, no-obligation case evaluation with an ERISA attorney.Get a Free Case Review
What Is ERISA?
The Employee Retirement Income Security Act (ERISA) governs most employer-sponsored long-term disability plans. Enacted in 1974, ERISA is a federal law designed to protect employees’ rights. ERISA regulates employer benefit plans, including pension, health, long-term disability, and retirement plans. ERISA sets minimum standards for these plans. Additionally, ERISA provides recourse for individuals who believe their rights have been violated, allowing them to file lawsuits against plan administrators.
How Do ERISA Attorneys Help with Long-Term Disability Claims?
ERISA attorneys are legal professionals who specialize in the regulations and procedures associated with ERISA-governed long-term disability claims. They possess deep knowledge of the law and are adept at handling the various stages of the claims process. In essence, ERISA disability lawyers act as advocates for claimants. ERISA attorneys may assist with filing a claim, appealing denied claims, and litigating cases in federal court.
ERISA is a framework of complex federal laws, regulations, and case law that apply to group disability insurance claims. Most attorneys, including those who handle Social Security disability claims, do not have the knowledge or experience to handle an ERISA-governed LTD appeal or federal lawsuit properly. A general practice attorney may miss administrative deadlines or fail to address critical issues in the appeal process. Unrepresented claimants risk making the same mistakes. So, we recommend you consult a lawyer regarding your LTD claim.
Recognizing Discriminatory Evidence Collection
Long-term disability companies are notorious for taking evidence out of context to make the claimant look bad. They may use video footage from the surveillance period in court to prove that the claimant is not truthful. Experienced long-term disability attorneys know how to recognize and dispute this.
For example, “Dottie” has a major back injury but was recorded taking out her trash. The insurance company says she isn’t really that injured since she was able to lift her trash bag into the trash can. The recording doesn’t show how much time Dottie had to rest and recover just from taking out her trash.
Appealing a Claim Denial
Unfortunately, most long-term disability claims are denied the first time they are submitted. The insurance company is looking for any reason to deny your claim. The most common reasons for a claim denial are missing information, incomplete forms, or missing medical records.
For example, if you write “Medical Hospital 234 Main St.” as your doctor’s address but forget to put “Suite 12,” they may try to deny your claim because you didn’t provide the complete address.
Other reasons may include insufficient medical evidence, procedural errors, and disputes over the definition of disability. The good news is you can appeal. In such cases, ERISA attorneys can prove invaluable in navigating the appeals process. The most critical stage in an ERISA disability claim (and the best time to hire an LTD lawyer) is the appeal stage.
An experienced long-term disability attorney can help you be more prepared when you submit your appeal, which could greatly increase your chances of being approved. Under ERISA, claimants can appeal denied claims within 180 days of receiving the denial letter.
An ERISA attorney can review the denial letter and identify weaknesses in the insurance company’s rationale. Once determined, the attorney can develop a strategy to address these issues during the appeal and gather and organize evidence to support your claim.
Additional evidence may include updated medical records, expert opinions, or vocational assessments to support the claimant’s case. They can also draft persuasive appeal letters that articulate the claimant’s entitlement to benefits.
It is important to note that the administrative appeals process is a critical stage in any ERISA-governed LTD claim. Your insurance company probably won’t tell you this, but your administrative file will be closed after you have exhausted your administrative appeals. This means you can no longer add evidence to your file.
So, if you show up to court with additional evidence, the judge will have to ignore it. You need to submit all of your evidence during the appeal process. We highly recommend consulting with an experienced ERISA attorney before filing an appeal.
Filing a Lawsuit in Federal Court
The insurance company may uphold the denial of benefits. Once a claimant has exhausted their appeal rights, they may have no choice but to file a lawsuit in federal court. Working with an ERISA attorney during the appeals stages can be instrumental in building a solid foundation for a successful lawsuit.
ERISA attorneys understand the unique procedures and standards that apply to ERISA litigation and can represent claimants in court effectively. Unlike traditional civil litigation, ERISA lawsuits typically do not involve live testimony or the presentation of new evidence. Instead, the court’s review is generally limited to the administrative record developed during the claims and appeals process.
ERISA litigation involves complex legal issues, such as determining the appropriate standard of review for the court to apply in assessing the insurance company’s decision and interpreting the terms of the LTD plan. ERISA attorneys can develop persuasive legal arguments, draft court filings, and present oral arguments to the judge on behalf of claimants.
In some cases, ERISA litigation may result in a negotiated settlement between the claimant and the insurance company. In other cases, the court may issue a judgment in favor of one party or the other. An experienced ERISA attorney can help claimants navigate these various outcomes and achieve the best possible result for their case.
Monitoring and Protecting Benefits
Once claimants are awarded long-term disability benefits, they may still encounter challenges. The insurance company reviews claims periodically and will request updated medical records. In some cases, insurers may attempt to terminate or reduce benefits based on their interpretation of medical evidence.
ERISA attorneys can continue to assist claimants who are receiving monthly benefits. An attorney can monitor their benefits and advise on how to respond to requests for information. An attorney can also intervene when necessary to protect their client’s rights under the LTD plan.
When to Hire an ERISA Attorney
Deciding when to hire an ERISA long-term disability attorney depends on your circumstances and comfort level. However, there are several key points in the ERISA claims process when engaging an attorney can be particularly beneficial:
- After Receiving a Claim Denial: If your initial claim is denied, an ERISA attorney can review the denial letter, identify weaknesses in the insurance company’s rationale, and develop an effective strategy for the appeals process.
- Exhaustion of Administrative Appeals: If the insurance company upholds the denial of benefits after the administrative appeals process, an ERISA attorney can represent you in federal court litigation.
- Benefit Termination or Reduction: If the insurance company attempts to terminate or reduce your benefits after they have been awarded, an ERISA attorney can protect your rights and help ensure you continue receiving the benefits you are entitled to.
Selecting the Right Attorney
When choosing an ERISA lawyer to represent you in your long-term disability claim, it is essential to consider several factors:
- Experience and Expertise: Ensure the attorney has a strong background in ERISA law and has successfully represented clients in similar cases.
- Communication: Choose a responsive lawyer who communicates clearly and keeps you informed about the progress of your case.
- Reputation: Research the attorney’s reputation, including peer reviews, client reviews, and professional accolades.
- Fee Structure: Discuss the attorney’s fee structure, which may include contingency fees, hourly rates, or a combination. Ensure you understand the costs involved and that they align with your expectations and budget.
Why Hire the Ortiz Law Firm?
ERISA disability attorneys play a vital role in helping claimants navigate the complex world of long-term disability claims. From appealing denials to litigating in federal court, these legal professionals advocate for individuals seeking the benefits they deserve under their LTD plans. By enlisting the assistance of a skilled ERISA attorney, claimants can increase their chances of obtaining a favorable outcome in their long-term disability claims and secure the financial support they need during challenging times.
The Ortiz Law Firm is dedicated to compassionate client service and outstanding results. Mr. Ortiz has over a decade of experience in representing disability claimants in seeking benefits and has the support of several paralegals and an office manager, working together to deliver the highest level of legal representation. We represent claimants whose long-term disability claim has been wrongfully denied or terminated. We are based in Florida but represent claimants nationwide.
Have your ERISA disability benefits been denied or terminated? We will fight to recover the benefits you are entitled to. Call ERISA lawyer Nick Ortiz at (888) 321-8131 to schedule your free, no-obligation case evaluation. We can help you evaluate your claim to determine how you should move forward with the process.