What is Required When You File an ERISA Claim?

If you are a participant in a group insurance plan provided by your employer, that plan is governed by the Employee Retirement Income Security Act of 1974 – ERISA. If you file a claim for disability benefits through your ERISA-governed insurance plan, what will be required? Will you need an attorney’s help?

If you’re disabled and can’t work, before you take any other step, schedule a meeting to discuss your disability benefits options with a California disability benefits lawyer at the McKennon Law Group. Reviewing your rights and options won’t cost anything, and there’s no obligation. Your attorney can determine what benefits you qualify for and help you obtain those benefits.

What Must Be Included With an ERISA Disability Insurance Claim?

If you are covered by an ERISA-governed insurance plan, and you are injured or disabled, what will be required when you submit your insurance claim? Along with other information and documents, you will need to provide three important statements:

1. You’ll need to prepare your own employee statement.
2. You’ll need to obtain a statement from your employer.
3. Your treating physician must complete an Attending Physician’s Statement.

The physician’s statement usually includes information about your diagnosis, symptoms, and medical history. It may also include the doctor’s recommendation that the patient stop working or limit his or her activities, and it may explain the projected course of treatment and any prognosis for your recovery.

Who Makes the Decision to Approve or Deny Your Disability Claim?

Is the insurance company obligated to accept the attending physician’s statement regarding the nature and extent of your disability? Not necessarily. Even if your attending physician states that you are disabled and qualify for benefits, it is the insurance company – and not a doctor – that will make the final decision to approve or deny your benefit claim.

Even the U.S. Supreme Court has upheld the right of an insurance company to deny an ERISA disability benefits claim when a doctor disagrees with the claim’s denial. In a 2003 case, the Supreme Court held that nothing in ERISA requires that an attending physician’s opinion should receive any special deference from an insurance company.

The Supreme Court softened its decision only slightly by adding that “Plan administrators, of course, may not arbitrarily refuse to credit a claimant’s reliable evidence, including the opinions of a treating physician.”

How Will a California Disability Benefits Attorney Help You?

If your own claim for disability benefits under ERISA has been denied by the insurance company – even though a doctor has verified that you are disabled – you’ll need to file an administrative appeal, and if you lose the appeal, you’ll need to file a lawsuit in federal court to obtain your disability benefits.

A California disability benefits attorney with the McKennon Law Group can advise you and act on your behalf through every step of the disability claims process, from helping you accurately complete your initial claim to handling a lawsuit if your claim is rejected and your administrative appeal fails.

How Can You Contact Us?

To schedule a review of your case – with no cost or obligation – call the McKennon Law Group now at (800) 682-4137, or you can reach us by completing the contact form on this website.

For more than seventy years, the attorneys at the McKennon Law Group have advised and represented working people and families who are involved in disputes with insurance companies, and we are ready to advise and represent you.