Why Are Most ERISA Disability Claims Denied?
The disability insurance offered through your employer may not be what you think it is. Claims for disability benefits under the Employee Retirement Income Security Act of 1974 (ERISA) are routinely denied with little explanation. If your own claim for ERISA disability benefits is denied, contact a California ERISA claims attorney, such as the McKennon Law Group PC, at once. They may be able to help.
ERISA sets minimum federal standards for the handling of group insurance plans offered by private-sector employers. If your ERISA-based disability insurance claim is denied, you should seek the advice and services of an ERISA claims lawyer.
Below, we will discuss the following: Why are most ERISA disability claims denied, at least initially? What are the common mistakes made by those who claim ERISA disability benefits? And how will a California ERISA claims lawyer help you reverse an insurance company’s decision to reject your disability claim?
Many ERISA disability claims are rejected, even disability claims that would be approved by the Social Security Administration or under a private (rather than group) disability policy. Here is a list of the most commonly-offered reasons for the denial of ERISA disability claims:
- an absence of medical evidence for a disability
- paperwork mistakes, missing details, and missed deadlines
- pre-existing conditions
- self-reported but undocumented symptoms and inappropriate treatment
- contradictory evidence gathered through private investigation or social media
- specific policy exclusions or limitations on coverage or benefits.
If you are severely injured or permanently disabled and you can’t work, you need to have your claim for disability benefits approved quickly and without unnecessary delays. But, sadly, a swift approval of your claim is unlikely.
Can the ERISA Rules Work in Your Favor?
In many ways, the ERISA rules tend to favor the insurance companies. In many states, a court will only order an insurance company to pay a denied claim for ERISA disability benefits if you and your attorney can prove that the insurance company’s decision to deny your benefits was “arbitrary and capricious.” However, in other states, the court can review the denial and reach its own “de novo” conclusion as to whether the person is disabled.
Furthermore, under the rules that took effect in 2018, an insurance company must now give you a “reasoned explanation” when it rejects your ERISA disability claim. The insurance company must explain why it disagrees with the doctor or doctors who have determined that you are disabled. The company also must spell out the policies and procedures it used when it arrived at the decision to deny your claim. These changes affect insurance companies in all states and, at a minimum, promote transparency as to why the insurer denied the claim. Recent changes require insurers to allow you and your attorneys to respond to new material that insurers are tentatively relying upon to deny a claim before they actually deny the claim. This gives a claimant some ability to attempt to reverse the likely claim denial.
What Is Required Before You Can Sue an Insurance Company Under ERISA?
At least one mandatory “administrative” appeal to the insurance company is almost always required before you may bring a lawsuit against that company.
If your ERISA disability claim is denied, consult a California ERISA claims attorney at once appealing the denial of your claim. The right lawyer can prepare your appeal and make sure that you have fully complied with ERISA’s many guidelines and that you have a fully developed Administrative Record for litigation should that be necessary.
ERISA is federal law, so federal courts have jurisdiction over all ERISA-related cases. If your administrative appeal to the insurance company is unsuccessful, your attorney will probably recommend filing a lawsuit against the insurance company in federal court.
Can You Reduce the Chances That Your Claim Will Be Denied?
An administrative appeal followed by a lawsuit in federal court is obviously a lengthy and burdensome process – especially for anyone who is disabled. You may wonder if you can avoid that process by having your claim for disability benefits approved at the start rather than denied.
Your best hope for having your ERISA-based disability insurance claim approved rather than denied is to obtain the advice of a California ERISA claims lawyer such as McKennon Law Group PC from the very beginning – before you complete the first piece of paperwork for the insurance company.
Your attorney cannot always make the insurance company process your claim faster, but your attorney can make sure that there are no misunderstandings on your end and no errors in the paperwork that could hold up your benefits or cause your claim to be rejected.
What Mistakes and Misconceptions Are Common When Claims Are Filed for ERISA Benefits?
There are many mistakes and misconceptions that the right ERISA disability claims lawyer can help you avoid – if you seek that lawyer’s advice before you make a claim for benefits.
For example, do not presume that you will be approved for disability benefits because a doctor says that you are disabled. And do not presume that simply having your doctor complete the standard forms is enough. Ask your doctor to write a more comprehensive explanation of your medical condition.
Also, follow your doctor’s instructions and do not engage in activities that your doctor forbids. The less you post on social media, the better. Do not give the insurance company any reason to conclude that you’re not truly disabled or that you don’t really need the benefits you’re claiming.
There are many other mistakes and misconceptions that the right ERISA disability claims lawyer can help you to avoid. Given the many errors that most claimants make when working alone, it is critical that a claimant find the right attorney. ERISA is a complex, detailed federal statute with a number of amendments, terms, conditions, exemptions, and deadlines.
When Should You Contact an ERISA Claims Attorney?
Certainly, if your ERISA disability claim has been denied, you should contact an ERISA claims attorney. But you may even want to hire an experienced ERISA disability claims attorney even before you file a disability claim. Attorneys such as McKennon Law Group PC provide advice and assistance to disability claimants who want an experienced ERISA attorney to shepherd them through the claims process. Your attorney must have substantial experience effectively representing clients whose ERISA-related disability claims have been denied. You will need the personalized legal advice that only the right California insurance claims lawyer can provide.
Some ERISA claims attorneys such as McKennon Law Group PC offer a first legal consultation with no cost or obligation. If you are disabled and applying for ERISA-based disability benefits, or if your claim for those benefits has already been denied, there is no reason for you to wait. Exercise your rights and make the call to an ERISA claims attorney, such as the attorneys at the McKennon Law Group PC, as quickly as possible.