The Financial & Emotional Toll
Whether you were working in a plant making minimum wage or serving your community as a physician, when your disability benefits are denied, there is a financial and emotional toll. Disability insurance is sold as a promise to make up for lost income when you are no longer able to work. Regardless of your financial stability, losing that income stream from your occupation takes a substantial toll on you and your family’s financial ability to meet your obligations.
What is less obvious is the emotional toll that comes from a wrongful denial of disability benefits. From the very first meeting with our clients, we begin addressing that emotional toll by explaining to you how the insurance company denied your benefits and what our investigation and experience with the insurance companies tell us about the denial of your disability benefits. When an insurance company denies disability benefits, there is an implied suggestion that your claim is frivolous and that you can return to work.
Understanding that the insurance company’s decision was simply a financial decision to save the insurance company money can blunt the impact of the insurance company’s suggestion that you are simply lazy or somehow over exaggerating the impact of your medical condition. A lot of the disability benefit denials we have seen have less to do with the merits of your claim and more to do with the insurance company’s desire to save money.
ERISA Disability Benefit Denials
The Employee Retirement Income Security Act of 1974 or ERISA was designed to protect employees. In fact, when President Ford signed the act on Labor Day, he said it was a great day for employees across the country. The law was a result of Congress being concerned about the theft of employee pensions by unscrupulous employers and third parties. The law covers pensions and employee welfare benefit plans. Your employee benefits such as life insurance, health insurance, disability insurance, and a 401(k) fall within what ERISA defines as an employee welfare benefit plan.
If you have a long-term disability or short-term disability insurance policy provided as an employee benefit or paid the premiums through payroll deduction, it is more likely than not that your disability insurance policy will be considered part of an employee welfare benefit plan. If that is the case, then ERISA will apply.
- An arbitrary and capricious standard of review, which requires you to prove the insurance company’s decision was both wrong and without any reasonable basis;
- No right to a jury trial;
- No punitive damages;
- No emotional or future damages;
- Often times there will not even be a trial, instead, the judge will simply decide the case based upon the lawyer’s written arguments contained in pleadings;
- You may lose the right to call witnesses or provide additional evidence in support of your claim;
- If you win your case, the most the judge can order the insurance company to pay is the amount of your past-due benefits and then send you back to the claims adjuster who already denied your claim once in order to get paid every month for the remainder of the policy.
- When your disability claim is governed by ERISA, you should not try to handle the claim by yourself. Take a few minutes to read through the details of what handling an ERISA claim requires and you may understand why we urge you to contact us regarding your long-term or short-term disability insurance policy. Trying to handle the claim yourself could limit your chances of winning in court if the insurance company denies your disability claim.
Bad Faith Disability Benefit Claims
Non-ERISA claims are subject to different laws in each state, so it is important to seek legal help. Even determining whether ERISA applies to a claim can be difficult in many cases, and insurers routinely take advantage of this uncertainty. This is why having an expert legal team to help you navigate these complex and often confusing issues is of the utmost importance.
When the insurance company has denied your benefit in bad faith, experience matters even more. Because we have litigated numerous bad faith claims against all the major insurance companies, we know how they will fight and what arguments they will make in court. With that knowledge and experience, we can improve the odds for you.
Sinclair Law Firm has the experience and skill necessary to ensure your ERISA or non-ERISA disability benefit claim denials are handled correctly and we fight to ensure you get the benefits you deserve. Our legal teams handle cases involving disability insurance for both ERISA (employer-provided) and bad faith claims (private policy) claims.
Contact Us for a Free Consultation
We invite you to explore our website, but more importantly, we invite you to call us and meet with us. Our initial consultation is provided free of charge.