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Long Term Disability
If your claim for Long Term Disability (LTD) benefits has been wrongfully denied, you need a qualified attorney with experience handling LTD claims, appeals and lawsuits. It is important that you retain an attorney early on, as disability insurance claims are usually governed by ERISA, and strict appeal deadlines apply.
Generally, under ERISA, once the internal appeals are exhausted and a lawsuit is filed, no more evidence can be submitted. The federal courts conduct what is called a “judicial review of the administrative record” (i.e. the claim file). There are no hearings or trial. Typically, neither the claimant nor the treating physician(s) are allowed to testify, and the Court simply reviews the narrative reports and records already in the claim file. Under ERISA, federal courts are to defer to the insurance company’s decision so long as there is a rational basis and reasoned explanation for the decision.
Your denial letter may refer to ERISA, which is short for the Employee Retirement Income Security Act of 1974. This federal legislation was designed to protect the pensions and retirement plans of American workers. Unfortunately, it also had the effect of granting partial immunity to insurance compasnies that handle health, life and disability insurance claims.
Under ERISA, Courts will overturn the insurance company’s denial only if the claimant shows that the denial was “arbitrary and capricious.” And, under ERISA , the best a claimant can do is recover the benefits owed. There are no consequential or punitive damages, and attorney fees are rarely awarded.
If your claim is not governed by ERISA – that is, you are either a governmental or church employee, or you purchased an individual disability policy paid out of your household budget (as opposed to through your employer) – you are in a much stronger position. The burden of proof is the same as a civil trial. That is, you must show you are disabled by the preponderance of the evidence. And, you may call witnesses, including yourself and your treating doctors, to testify at a trial by jury.
Disability claims are complicated and governed by various laws and regulations, both state and federal. There are many case-made rules, and subtle issues such as offsets, limitations of benefits due to mental illness, waiver of premiums, coordination with health insurance, and exclusions for pre-existing conditions.
Will Driscoll 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 Disability Income policy.
Will Driscoll has represented disability claimants in claims against the major disability insurance companies, including UNUM Provident, Metlife, CIGNA / LINA, Anthem, Aetna, Lincoln Financial, Prudential, MassMutual and the Hartford. |
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