ERISA law is governed by Federal Statutes and was established to set guidelines for employers to help protect employee’s benefits, such as retirement, disability, health, welfare and other employment-related benefits. The legal guidelines are set forth in the Employer Retirement Income Security Act of 1974, otherwise know as ERISA (found in U.S. Code Title 29, Chapter 18). Many insurance companies fight against the benefits they owe at a time when people are most vulnerable.
1) Consult Your Policy: Many people make the mistake of applying for disability benefits without thoroughly consulting their policy first. The policy will define what your carrier considers to be disabled, how your benefits will be calculated, crucial deadlines, limitations on benefits, and evidence they will or will not consider in making a determination about your claim.
2) Filing the Claim: You must first file your initial claim with the insurance company. The insurance company will make a determination to either pay or deny the benefits under the policy. If your claim is denied, have the right to appeal the decision. This is a critical step in the proceedings and will go a long way to determining if you will get the benefits that are rightfully owed to you or not.
3) The Appeal: First and foremost, your denial letter will contain a time deadline which you need to comply with in appealing the decision of the insurance company. If you miss the deadline or waiting too long to get help it can mean the end of your claim for which you will be barred.
To make the most of your appeal, you need to know what is contained in your claim file. once you get a denial IMMEDIATELY write the insurance company and demand a copy of the policy and CLAIM file from the carrier. These two items are crucial in preparing your appeal so that if they deny your appeal, all the necessary information will be contained within the claims file to better help your future lawsuit. THIS will be the ONLY evidence the court will review when making a determination if the insurance company improperly denied your benefits or not.
4) The Lawsuit: In an ERISA lawsuit, you DO NOT get a jury trial. The court, at best, will have a very brief hearing, but will more commonly just review the paper briefs and the claims file to make a determination of wehther or not the insurance company either abused their discretion or if there is a preponderance of the evidence to overturn the denial of benefits. Needless to say, the deck is stacked in the insurance companies favor.
If you have a claim which is governed by ERISA, you need an attorney who can help you every step of the way. Because the legal and procedural rules applied to ERISA claims are complex and very confusing, our office stands ready to help you. We can help you with your appeal of your denial of benefits as well as handle your case in the Federal Courts. Contact our office today to discuss what we can do to help you get the benefits your deserve.