Long Term Disability Under ERISA
ERISA Disability Lawyer in Louisiana
The Employee Retirement Income Security Act (ERISA) is a federal law that was originally enacted to protect employees’ rights to their benefits. Ironically, it is now widely accepted that ERISA protects insurers, not claimants as intended.
Here are some reasons why:
ERISA disability disputes can be very drawn-out
Before any federal lawsuit, a denied claimant must “exhaust administrative remedies” by appealing to the insurance carrier in writing. The time to appeal is limited: Denied claimants have 180 days to appeal, and insurers have up to 90 days to consider the appeal.
Click here for Department of Labor filing information
By the time the internal appeal has concluded, 270 days have elapsed. During that time, the disabled person is without income from his or her job.
- Should the disabled person seek social security, the long-term disability insurer usually is able to deduct SSD (Social Security Disability) from the amount it owes the claimant.
- Should the disabled person not seek SSD, the long-term disability carrier may argue that the disabled person breached an LTD (Long Term Disability) policy requirement that social security be applied for.
ERISA disability appeals
Since appeals will be based on medical evidence in the claim file, it is crucial that the claim file be stacked with evidence supporting the claim early on.
As strange as it sounds, ERISA allows insurers discretion to administer their own policies. If such discretion is given under the plan, then a denial can be overturned by showing that the insurer abused that discretion—a very tough standard.
Should the denial be affirmed after the internal appeal, then a suit in US District Court is the final option. But suit under ERISA does not amount to “one’s day in court” because testimony is usually not allowed and cases are decided by judges, not a jury or one’s peers.
Instead, cases are decided based on briefings of attorneys who argue based on the evidence in the claim file. That is why properly setting up the claim file in the first place is so crucial.
In reality, few disabled persons have the stamina or resources to put up a fight against calculating and powerful disability insurance companies. Insurers know this.
The Wanko Law Firm takes viable long-term disability cases on a contingency basis. If you have been denied LTD benefits, call today or complete our online evaluation form today to see if you qualify. We can help.