If you have purchased a long-term disability plan, or had such coverage provided to you by your employer as part of a benefits package, you are entitled to long-term disability benefits if you become disabled.
If your claim for Long Term Disability (LTD) benefits has been denied, you have the right to appeal such a long term disability benefits denial and my firm can help you fight to recover LTD benefits which have been wrongfully denied. It is important that you retain an attorney as soon as possible after the denial, as disability insurance claims are usually governed by ERISA, and strict appeal deadlines apply.
ERISA, (Employee Retirement Income Security Act of 1974) is federal legislation designed to protect the pensions and retirement plans of U.S. workers. Unfortunately, it also had the effect of granting partial immunity to insurance companies which handle disability insurance claims.
For ERISA based policies, once the internal appeals are exhausted and a lawsuit is filed, no more evidence may be submitted. The Court then conducts what is called a “judicial review of the administrative record.” There are no hearings or trial and, generally, neither the claimant nor the treating physician(s) testifies. Instead, the Court reviews the medical reports and records already in the claim file. Under ERISA, federal courts are to defer to the insurance company’s decision (i.e. their denial) so long as there is a rational basis and reasoned explanation for the decision. A Court will only overturn the insurance company’s denial if the claimant shows that the denial was “arbitrary and capricious.” Further, in ERISA based claims, the claimant can only recover the disability benefits owed. One cannot recover consequential or punitive damages, and attorney fees are rarely awarded.
If the disability policy is not governed by ERISA (i.e. you are either a governmental or church employee, or you purchased an individual disability policy for which you paid the premiums, as opposed to an employer-based plan), you are in a much stronger position. In Court, you must show you are disabled by the preponderance of the evidence. However, you may call witnesses, including yourself and your treating doctors, to testify at a trial by jury.
For further information about disability denial, please visit our website dedicated exclusively to Long Term Disability Denial/ERISA.
My office can help you with your LTD claim, whether your LTD policy is part of an employer sponsored plan governed by ERISA, a group plan or an individual LTD policy. If you, a family member or a friend have been denied LTD benefits, please call me as soon as possible after the denial, so I may review your case.