Long term disability (LTD) insurance is a crucial safety net for many employees. These benefits provide financial security in the event of 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.
The Employee Retirement Income Security Act (ERISA) governs most employer-sponsored long term disability plans. ERISA attorneys or ERISA lawyers play a pivotal role in helping claimants navigate this complex legal landscape. We will explore the role of an ERISA attorney and how they can help you get the benefits you deserve.
Have your ERISA benefits been denied or terminated? Read on to understand how an ERISA attorney can help you recover the benefits you are entitled to. Call ERISA attorney Nick Ortiz at (888) 321-8131 to schedule your free, no obligation case evaluation.
What Is ERISA?
Before delving into the role of ERISA attorneys, it is essential to understand the basics of ERISA itself. 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.
ERISA Attorneys: Who They Are and What They Do
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.
ERISA attorneys may assist with filing a claim, appealing denied claims, and litigating cases in federal court. In essence, ERISA disability lawyers act as advocates for claimants. They ensure claimants receive the benefits they are entitled to under their employee benefit plans.
The Role of ERISA Lawyers in Long Term Disability Claims
Claim Denials and Appeals
Unfortunately, insurance companies often deny long term disability insurance claims. Reasons include insufficient medical evidence, procedural errors, or disputes over the definition of disability. In such cases, ERISA attorneys can prove invaluable in navigating the appeals process.
Under ERISA, claimants have the right to 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 identified, the attorney can develop a strategy to address these issues during the appeal.
The appeals process involves submitting additional evidence. Additional evidence may include updated medical records, expert opinions, or vocational assessments to support the claimant’s case. ERISA attorneys can help gather and organize this evidence. 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. The evidence submitted during this time will likely form the basis of the “administrative record” if the case proceeds to litigation. We highly recommend consulting with an experienced ERISA attorney before filing an appeal.
Litigation 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 conducting periodic reviews of their medical condition or requesting updated medical records. In some cases, insurers may attempt to terminate or reduce benefits based on their interpretation of the ongoing 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 requests for information. An attorney can also intervene when necessary to protect their clients’ rights under the LTD plan.
When to Hire an ERISA Attorney
Deciding when to hire an ERISA long term disability attorney depends on your individual 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 intervene to protect your rights and ensure you continue to receive the benefits you are entitled to.
Selecting the Right ERISA Lawyer
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 an lawyer who is responsive, 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 of both. Make sure you understand the costs involved and that they align with your expectations and budget.
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 act as advocates 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.
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.