What Every Disability Policy Holder Needs To Know About ERISA

“ERISA” stands for the Employment Retirement Income Security Act that was enacted in 1974 as a result of the Jimmy Hoffa’s pension scandals.   The United States Congress wanted employers to provide to its employees a pension, health insurance, disability insurance and other employee benefits.  To make this insurance affordable, employers asked for legislative protection from being sued. See our practice area page about LTD ERISA Attorney.

What Are The Legislative Protections of ERISA?

Preemption

If you have to file a lawsuit to get your benefits, it must be filed in Federal Court.  The ERISA statute preempts or prevents you from filing virtually all state law claims such as breach of contract, fraud, misrepresentation and tort claims.  If you have to file a lawsuit for the payment of benefits, the courts will rarely award attorney fees and costs at the expense of the insurance company or the plan.

Standard Of Review

The primary ways that insurance companies have controlled the costs of policies is a clause in the insurance policy that gives the insurance company the discretion to make the decision to pay or deny benefits.  This “deferential” is a standard of review makes it difficult, if not impossible, for a Federal Judge to substitute their decision for that of the insurance company.

Requirement That Policy Holders Exhaust Their Administrative Remedies Before Filing An Appeal.

There is no bench or jury trial in an ERISA claim.  That means that the administrative appeal you make after your claim is denied is your trial.

It’s crucial that your appeal contain all of your medical records, the medical statements of your treating physicians, vocational opinions, citations to relevant plan provisions, an analysis of why the claim was improperly denied are decided and references to supporting case law. This isn’t a “do it yourself “ project and requires the services of an experienced disability attorney.  Ms. Cavey’s appeal letters are 25 to 75 pages long and are a “shock and awe” appeal package.

Resolution of the Case on Cross Motions for Judgment.

An ERISA claim is based on the administrative record which, unfortunately, is often just the carrier’s claim.

There is limited discovery in ERISA to challenge procedural due process violations or bias.  Carriers typically fight written discovery requests and depositions.  Ultimately, the Court decides your case on cross motions for judgment based on the administrative record.  There is rarely oral argument.  Unfortunately, many Judges rule in favor of the insurance carrier because of the differential standard of review.

What You Should Do If Your ERISA Disability Claim is Denied

You only have 180 days in which to file an appeal.  Don’t delay contact ERISA disability attorney, Nancy L. Cavey who can represent you regardless of where you live in the United States to help you get the disability benefits that you deserve.  Don’t let the disability carrier rob you of your peace of mind!

Call today at 727-477-3263.