I am often asked: “What is the most common trap that you see individuals falling into when it comes to ERISA claims?” The answer is simple: people wait too late before getting a lawyer to help them with their claim.
Would you go into a courtroom and represent yourself in a trial against a team of insurance lawyers? If I were injured in an automobile accident due to someone else’s negligence or I was injured by a trucking company, one of those massive eighteen-wheelers out there on the road, I would not go to court by myself. I am a lawyer, and I have been doing this for more than 20 years, and I can tell you despite having tried many cases in front of juries, I would not take a type of case I was not experienced in.
In a claim that is governed by ERISA, your trial occurs during the administrative process. If you go through that administrative process and find yourself in front of a federal judge, you are going to potentially have a situation where that judge will only look at the evidence presented during the administrative process.
For example, let us say that the insurance carrier denies your life insurance claim or your disability claim and it is an ERISA-governed benefit. You take that denial and write a nice letter explaining why it is wrong and send it in. Then, the carrier denies your appeal. That is the end of the administrative process and they will not look at any more argument or evidence from you – they’re done. You then file a lawsuit in federal court. Aside from what the insurer claims it obtained or created, the only evidence the judge may consider is your letter. A lot more goes into preparing a case for trial than simply writing a nice letter saying the insurer is wrong. In an ERISA case, you must submit all the evidence during that administrative process that you want the judge to consider if and when you get to federal court.
The trial in an ERISA case is going on during the administrative process. Do not try to take your case to trial without a lawyer on your team. Do not try to do it yourself. Get a team of lawyers to work on your behalf.
Read more in our article featured in the Alabama Association for Justice Journal