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The Employee Retirement Income Security Act (ERISA) is a federal law covering private employer-sponsored benefits like 401 (k) plans, health insurance, and disability coverage. If you work for a private employer that provides long-term disability benefits, or you are a self-employed professional who purchased group benefits through a professional organization, your plan is likely covered by ERISA.
If you have a dispute regarding your disability benefits, ERISA establishes the procedures you must follow, and any deviation can mean a denial of your claim and limit a successful appeal. Work with a Nashville ERISA lawyer who focuses on this area of law and represents people from around the country. The attorneys at Cody Allison & Associates can prepare a robust appeal to overturn a claim denial.
Some companies buy insurance policies to provide disability benefits to their employees, and others self-insure. Either way, although the plan administrators have a legal obligation to act in the best interests of the insured, the company has a financial incentive to limit the funds paid to claimants.
ERISA requires companies and insurers to fully disclose what is covered, but their rules are often complex. They may wrongfully deny a legitimate claim because the medical documentation does not adequately address a given issue or does not describe a limitation clearly enough. Sometimes the insurance company relies on outdated or biased medical opinions to deny a claim.
There are cases where the medical documentation is not the problem. Sometimes an insurance company fails to disclose changes to its policies and procedures, and a claimant may not comply with the company’s rules because they were not made aware of them. Our Nashville-based ERISA attorney could contact an insurer on behalf of a claimant anywhere in the country to contest a decision made on this basis.
If an insurance company denies your disability claim or terminates benefits you are already receiving, it must state its reasons. This denial letter will form the basis of any appeal.
The appeal is an administrative remedy, which means it does not go to court. Rather, the insurance company establishes a procedure for the internal review of denied claims and an opportunity for a claimant to provide additional information. ERISA rules require the insurer to offer at least one level of administrative appeal, and many offer two.
If your disability claim is denied, get in touch with our ERISA attorneys in Nashville immediately. You typically must file an appeal within a short timeframe, and we will need to thoroughly review the claim and compile the documentation necessary to persuade the plan administrator to reverse its decision.
You must exhaust your administrative remedies before you can take an ERISA appeal to court. If your insurer offers two opportunities for an administrative appeal, they must both be denied before you can file a court claim.
You must bring your appeal in federal court, and it will be heard by a judge without a jury. The judge does not hear witnesses or accept new testimony. The decision is based solely on the record you built during the administrative phase of the appeal process.
This process favors insurers and makes it difficult—though not impossible—to persuade a judge to overturn the insurer’s denial. Your best chance for success is to work with a Nashville lawyer on your initial ERISA administrative appeal, so that they can build a compelling record to convince an insurer to rethink the denial.
When you are disabled, the disability benefits your employer sponsors may feel like a lifeline. Do not let an insurer deny you critical benefits without a fight. Contact a Nashville ERISA lawyer at Cody Allison & Associates today.