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Your doctors say you’re disabled. The insurance company says you’re not. Your employer’s disability benefits plan should be your safety net, but too often legitimate claims are denied. When you need to enforce your right to short-term or long-term disability benefits, you need a lawyer who understands ERISA law.

What Is ERISA?

The Federal ERISA law applies to all employer-sponsored health and benefit plans, and unfortunately, it stacks the deck in favor of the insurance companies. Under ERISA, you don’t get a jury trial and you don’t get to have your doctors testify in court. Instead, a Federal Judge reviews the insurance company’s file on your claim and decides based on the file whether it was reasonable or unreasonable for the insurance company to deny your claim. Because the Judge will only see what you have already submitted to the insurance company, it is critical to get help with a denial of disability benefits while you can still appeal the denial internally to the insurance companies.

If your short-term or long-term disability benefit claim is denied, read the denial letter carefully:

  • Usually you only have 180 days (or 6 months) to submit an internal appeal to the insurance company.
  • Usually you only get one appeal and one chance to fill the insurance company’s claims record with all of the medical records and other evidence to support your claim.
  • You have a right to request and receive a free copy of your claims file.
  • You have a right to request and receive a free copy of the disability plan or policy.
  • And while the insurance company won’t tell you this, you have a right to hire a lawyer at your own expense to help you with your appeal and to help you make certain the claims file is as strong as possible in the event a Federal Judge has to review your claim.

Please contact Christine A. Hopkins (christine@tremainartaza.com) if you want to consult with an attorney about your short-term or long-term disability benefits claim.