In October 2017, I received an email from a long-term disability defense attorney announcing his involvement in a webinar. The webinar’s title was “ERISA Wrongful Denial of Benefits Claims: Procedural Prerequisites and Key Defenses.” The email laid out the issues they were going to cover, which gives you insight into how an insurance company will be looking at your claim.
The beginning of the email says, “We will review these and other key issues:” The first key issue was, “How can plans preserve and maximize their procedural and substantive defenses through plan design?”
A plan is the insurance policy, which means they are laying out how one can design it to maximize the insurance company’s ability to deny your claim.
The second key issue was, “What has been the impact of recent case law on the review of claim administrators’ determinations?”
Again, they’re saying, “How can you incorporate recent court decisions into your plans and policies to maximize your opportunity of denying future claims?”
The following paragraph was also very insightful into how they view these cases. It says, “ERISA litigation remains steady, including cases brought by plan participants, beneficiaries and providers challenging denials of benefits. Defending benefits denial cases involves several procedural and substantive tactics.”
So again, they’re laying out all the different ways and strategies they can use to deny legitimate claims.
The following paragraph said, “Counsel must be vigilant in leveraging effective defense approaches.” It says, “Potential tools in the defense attorney’s arsenal include lack of standing, preemption, failure to exhaust administrative remedies, expiration of the statute of limitations and claims-based limitations defenses.”
Again, they’re laying out all the strategies that can be used to deny claims.
The following paragraph: “Effective plan design, careful structuring of the administrative process, and informed guidance to those who administer claims can greatly increase the precision of claims administration and maximize the likelihood and success in benefits denial litigation.”
So it says straight out in that sentence that their whole goal is to maximize the denial of benefits. They conclude by saying, “Our panel will provide guidance to employee benefits counsel for defending against wrongful denial of benefits claims involving ERISA plans.”
I’m pointing this out to you because this is from a defense attorney who was directing this webinar towards defense attorneys who defend these insurance companies in the long-term disability appeal process and also to insurance companies themselves, trying to educate them on how they can structure their plans and insurance policies to maximize the opportunity for future denials of benefits. They do not have your best interests in mind.
That’s why fighting back against these insurance company tactics is so important. One of the best ways of doing that is to hire an experienced long-term disability attorney like Nick Ortiz to help you with your claim. Here at the Ortiz Law Firm, we have handled these claims since 2012. If you’d like to talk to our office, call us at (888) 321-8131. We look forward to hearing from you.
