My name is Brandon Osterbind and I’m an experienced ERISA disability lawyer in Central Virginia. We help people whose long-term disability insurance claims have been denied by the insurance company.
ERISA protects employee benefits, ensuring that long-term disability benefits are safeguarded. It also ensures that insurance companies adhere to transparency and accountability standards. And the question that you should ask every attorney is, “Do you have long-term disability experience?”
Introduction to ERISA
ERISA, the Employee Retirement Income Security Act, is a federal law that regulates employee benefit plans, including long-term disability benefits, pension benefits, and health insurance.
Enacted in 1974, ERISA sets minimum standards for employee benefit plans in the private sector, aiming to protect employees’ rights and ensure fair treatment by insurance companies. Understanding ERISA is crucial for employees and employers alike, as it governs the rules and procedures for filing and appealing disability claims.
An experienced ERISA disability lawyer can help navigate the complexities of ERISA. They ensure that employees receive the disability benefits they are entitled to.
Why you must ask that question
I’ll tell you why you need to ask that question. Because ERISA long-term disability cases are unlike any other cases I have seen as a practicing attorney.
ERISA lawyers play a critical role in navigating the complexities of these claims. They protect your rights and fight to make sure you receive the benefits you’re entitled to.
For example, divorce cases, criminal defense or prosecution cases, personal injury cases, workers comp cases, they’re all different because you can present evidence and call witnesses and give the judge documents in a hearing, in a court of law. You have your day in court, so to speak.
ERISA cases are different
But in ERISA disability cases, you don’t have your day in court and you never get to go testify in front of a judge. What the statutory scheme creates is a system wherein the insurance company ultimately has the right to determine what is a fact and what is not a fact.
The goal in an ERISA disability appeal is to make sure that the insurance company has all of the information that it might need to fight in your favor when it is making the decision about whether to grant you benefits or not, especially in the face of claim denials.
I know it sounds strange—you’re essentially asking the same insurance company that denied your claim to now fairly review that decision.
It doesn’t make much sense, but that’s how the ERISA process works.
Why your attorney really needs experience with ERISA claims
And that’s why I say that your attorney really needs to have experience handling these long-term disability ERISA claims. An experienced ERISA attorney can help you explore all legal options available to contest a denied claim and ensure you receive the benefits you deserve. Because if your lawyer doesn’t understand that, he or she might be thinking in the back of his or her mind, “I now have an opportunity to go and put on my case.”
Role of the Plan Administrator
The plan administrator plays a vital role in the ERISA process, as they are responsible for managing and administering employee benefit plans.
This includes processing disability claims, making determinations on eligibility, and communicating with employees and insurance providers.
Under ERISA, plan administrators must act in the best interests of plan participants and follow a fair and transparent process when making decisions. However, in some cases, plan administrators may deny benefits or make decisions that are not in the best interests of employees.
In such situations, an ERISA attorney can help employees understand their rights and options for appealing the decision.
How things work in most other cases
Because for example, in a personal injury case, when I, as the lawyer, send a demand to the insurance company and the insurance company responds by saying, “Your case isn’t worth that,” then I’ll turn around and I’d have to file a lawsuit. Well, in that lawsuit, I will later have an opportunity to present my case or to present the evidence in my client’s case.
In non-ERISA disability claims, the parties resolve disputes using standard contract law principles, which differ significantly from the federal rules that govern ERISA policies.
How disability benefits work in ERISA cases
But in ERISA disability cases, it’s just not like that. You have to appeal the decision of the insurance company that said, “No long-term disability benefits.”
And during that appeal, it is your job to make sure that they have enough information in their file that when a federal judge reviews it later, the judge can say, “Yes, they indeed have abused their discretion and I will reverse that decision.” You must go through the internal appeal process before pursuing legal action, and it plays a crucial role in building a strong case.
ERISA and Federal Court
Federal judges typically hear ERISA claims in federal court and decide the case based on the evidence presented.
The ERISA statute requires that employees exhaust administrative remedies before filing a lawsuit in federal court. This means that employees must first appeal the denial of their disability claim to the insurance company before seeking relief in court.
An experienced ERISA lawyer can help guide employees through this process and represent them in federal court if necessary. It’s essential to note that ERISA law preempts state laws, which can limit the remedies available to employees in certain circumstances.
Settlements and Negotiations
In some cases, it may be possible to negotiate a settlement agreement with the insurance company, avoiding the need for a lengthy and costly lawsuit. An ERISA attorney can help facilitate these negotiations and ensure that employees receive a fair settlement.
However, it’s crucial to understand that insurance companies may not always act in good faith, and employees should be cautious when negotiating a settlement. An experienced ERISA disability lawyer helps employees navigate complex negotiations and protects their rights throughout the process.
Additionally, ERISA requires that insurance companies provide employees with a fair review of their disability claim, and employees should be aware of their rights and options throughout the process.
What you should do if your insurance company denies your claim
Make sure that the attorney you hire to represent you in a long-term disability claim has plenty of experience handling these long-term disability claims.
We offer a free strategy session to discuss your long-term disability claim and help you understand your legal options.
And if you have any questions about how the system works or whether you should hire an attorney for your long-term disability claim, feel free to reach out to us. You can email us or call us. Either way, we’ll be happy to speak with you and happy to help.
