Frequently Asked Questions

Potentially yes, though this depends on your short-term disability policy and your workplace. It also depends on how pregnancy and/or childbirth have affected your ability to work and what medical evidence can be provided with your claim.

Yes, you can apply for short-term disability if you experience behavioral and mental issues such as depression, anxiety, and post-traumatic stress disorder (PTSD). However, the claim approval process for mental health crises can be more challenging.

Yes, though that is not always the case. This is dependent on your employer and whether they allow retirees to maintain their life insurance benefits after they’ve finished working.

If you or your spouse has retired and you have concerns about your ERISA life insurance coverage from your old company, reach out to your plan advisor or old employer for more information.

If your ERISA life insurance benefits are denied, you’ll be asked to gather specific documents to help support your appeal. This may include:

• Death certificate
• Medical or employment records
• Plan documents
• Relevant communications with the employer or insurer

When you reach out to Sinclair Law Firm, we can give you a full list of what you’ll need. Tom and his team will discuss what other supporting evidence we’ll include to make sure you have a strong legal foundation in your appeal.

Under ERISA rules, a married person is required to list their spouse as the primary beneficiary of a life insurance policy unless the spouse provides written consent otherwise. Other possible beneficiaries include children, close family members, and other designated dependents.

Some of the most common reasons a person’s ERISA life insurance gets denied include:

• An alleged lapse in coverage
• Loss of benefits from termination
• Failure to convert coverage after leaving a job
• Alleged mistakes or misrepresentations on forms
• Failure to provide “proof of insurability”
• Disputes over beneficiary designation

Your denial letter will include the reason(s) for your claim denial as well as instructions on how to appeal. Your attorney can build a strong appeal based on the reason(s) your claim was denied, and look for strong supporting effort that helps demonstrate the abuse of discretion standard.

Any time you feel an insurer acted in bad faith, we recommend that you review your insurance policy, gather the denial letter and any other documents from the insurer, and request a free claim review at our Birmingham law office. We can determine if you have a viable bad faith claim and begin the process of holding the insurer accountable.

No, your existing insurance coverage should not be impacted by filing a lawsuit as long as you continue to meet the terms in your policy. However, some insurers may retaliate against you because of the bad faith claim. Let Sinclair Law Firm know if you notice that your premiums have gone up or if your insurance policy is not renewed.

Yes. Just because you were paid does not mean the insurer acted in good faith. Any delays or misconduct that causes you to wait for payments or experience a financial loss are grounds for a bad faith claim. In fact, the insurance company may have been lowballed you with their initial offer, and that can also be grounds for a bad faith claim.

Not necessarily. Many insurance bad faith claims settle outside of court rather than going all the way to a jury trial. As we work on your case, we’ll keep you updated about settlement negotiations and whether it’s worth going to court to maximize compensation. If we do go to trial, we’ll be a fierce advocate for you every step of the way.

The following employee plans are not subject to ERISA regulations:

• Workers’ Compensation Benefits
• Unemployment
• Social Security Disability Benefits
• Government Employee Plans
• Church/Religious Employee Plans
• Small Insurance Plans
• Plans of Indian Tribal Governments
• Insurance Plans Outside of the U.S.
• Unfunded Excess Benefit Plans

As a general rule, ERISA does apply to exempt employers and exempt plans.

• Exempt employers include government employers and religious employers. For government employers, their plans tend to be subject to other federal laws or state laws. For religious employers, federal ERISA laws do not apply, which is one way that the church and state are kept separate.
• Exempt plans include any plans that you do not have through your employer. This applies to any insurance you paid for yourself out of your own pocket (i.e., not through payroll deductions) as well as plans subject to other laws, such as workers’ comp and certain kinds of disability coverage.

Learn more about plans that are not subject to ERISA regulations.

“LWOP” stands for Life Waiver of Premium. This is a provision that may be included in a life insurance policy that allows the beneficiary to stop paying premiums but continue receiving benefits if they become disabled. We can determine if this applies to your situation and help you understand this separate claims process.