Did The Hartford deny your ERISA long-term disability claim?
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Have you received a denial letter from The Hartford regarding your long-term disability claim in Virginia?
If so, you are faced with a daunting task in a limited timeframe. The Hartford is aware that most individuals would struggle to gather the necessary documentation to successfully appeal a long-term disability and ERISA claim after being denied. By denying your claim, they avoid paying out benefits, fully aware that you are disabled and unable to work.
However, the consequences are significant because you only have one chance to appeal, and the deadline for doing so is 180 days from the date of your denial letter. Waiting around could result in losing your case altogether, and if long-term disability benefits are your primary means of supporting your family, it is crucial to start planning your next steps as soon as possible.
ERISA long-term disability cases in Virginia are subject to short deadlines and require prompt action, unlike many other cases.
What is an ERISA Disability Policy?
ERISA is an acronym for the Employee Retirement Income Security Act, which comprises a set of federal laws regulating the benefit plans offered by Employers to their employees. The Act oversees various types of insurances such as health insurance, dental insurance, vision insurance, 401k’s, as well as short-term and long-term disability insurance.
The regulations under ERISA are stringent, and federal courts are typically unsympathetic. They do not provide the claimant with the benefit of the doubt. Instead, the courts treat both parties equally, often to the claimant’s disadvantage, particularly if they do not have legal representation to guide them through the process.
In Virginia, if you are seeking long-term disability benefits, it is typically due to a severe medical condition such as chronic fatigue syndrome, musculoskeletal problems like back injuries, cardiovascular diseases such as heart failure or coronary artery disease, cognitive impairments such as traumatic brain injury, respiratory diseases like asthma or COPD, or even cancer.
These diagnoses are challenging, often requiring extensive medical treatment and periods of rest.
At this point, you can do three things:
DO NOTHING
If you are defeated, you can stay down and lose the right to pursue your claim at all in the future. By not doing anything or waiting too long, it will be too late to accomplish any degree of success.
HANDLE THE APPEAL ON YOUR OWN
You can work up your appeal on your own by filling out the insurance companies limited forms and hope for the best knowing that the insurance company has more resources and knowledge about how these claims are resolved. At the end of the day, this may cost you.
HIRE AN ATTORNEY
An attorney should be able to review your medical records, job description, and educational and training history to tell you what your chances of success may be. Then, develop a plan to prevail.
Hiring an attorney is the best option
When federal judges look at these types of cases, they see inequality for people compared to the vast experience of the insurance companies. One federal judge said:
“The Court also recognizes that ERISA claimants may not have the advantage of legal advice or favorable referrals before the administrative process is complete, placing such claimants at a distinct disadvantage if discovery is not permitted on judicial review. For ERISA claimants not able or aware enough to hire legal counsel before the administrative process is complete, they likely enter into judicial review facing a loaded deck–a deck loaded with the expert opinions of those hired by the plan administrator and, with the possible exception of a treating physician or two, lacking the opinions of vocational or medical experts hired by the claimant. Further, if the plan vests discretion with the plan administrator, as almost all do, such claimants also face the hurdle of a discretionary standard of review.” – Abromitis v. CNA, Reporter, 261 F. Supp. 2d 388 (F. Dist. Ct. W.D.N.C 2003).
This isn’t just me saying it, this is a federal judge. If you don’t want to face a loaded deck, you need to start looking for an attorney.
The best time to consult a long term disability lawyer is right away.
What Judge Cogburn is saying here is that ERISA long-term disability cases are different than almost every other case.
In a personal injury lawsuit, there are several steps you can take to build your case, including filing your lawsuit, submitting written questions to the other party, scheduling a deposition, finding new witnesses, and ultimately presenting your evidence to a judge or jury. However, the same does not hold true for ERISA long-term disability cases.
In the case of ERISA long-term disability claims, the opportunity to present evidence is limited to the appeals process with The Hartford, the company responsible for paying the benefits. As a result, there is a clear conflict of interest, which may work in your favor if you know how to build a strong case.
Ideally, having a lawyer file the notice of your disability and draft the initial disability claim application is crucial. A lawyer can help identify potential areas where The Hartford may object to your claim, such as nitpicking through your medical records to find statements taken out of context. Addressing these potential issues early on is essential to increase your chances of winning the claim.
Additionally, there are strict deadlines for filing your claim, and failing to meet these deadlines may result in missed opportunities. With the help of a lawyer from the outset, many of these issues can be avoided.
The second best time to consult a long term disability lawyer is after your claim has been denied.
Once your long-term disability claim has been denied by The Hartford, it is imperative to seek the advice of a lawyer immediately, as time is of the essence, and significant work must be done to overturn the initial decision. A competent lawyer will begin by gathering all relevant information regarding your claim, including your medical and vocational records and the entire claim file, as this may be your last opportunity to present new evidence to support your claim.
Your lawyer will investigate the reason for The Hartford’s denial of your claim, as insurance companies often provide vague explanations that lack clarity. If this is the case, your lawyer can compel the insurance company to provide more specific reasoning, allowing you to address each issue raised by the company.
Your lawyer can also obtain additional evidence to support your claim, especially if The Hartford denied your claim due to a lack of objective evidence. Your lawyer should be familiar with the appropriate tests, exams, or images that would provide the necessary objective evidence and work with your healthcare providers to obtain this information. Your lawyer can then present this evidence in a compelling manner to the insurance company.
Hiring a lawyer should make your life easier, not harder.
Call us at 434-515-2807.
We provide free strategy sessions to individuals seeking our assistance in reviewing their claims.
Whether you are contemplating applying for long-term disability benefits or have already received a denial and require an appeal, we will arrange a meeting with you to discuss the strength of your claim and develop a strategy for moving forward.
Our strategy sessions are offered free of charge, and there is no obligation or pressure to take any particular course of action. Instead, we will present you with all available options and work with you to establish a practical strategy. To schedule a strategy session, please contact us via phone or email, and we will be pleased to speak with you.
We also have several videos with answers to the most frequently asked questions that people have after their long-term disability claim was denied.
We represent claimants for long-term insurance disability claims against The Hartford.
Employers often provide long-term disability insurance policies as part of their employment benefits. Although these insurance companies accept the premium payments from employers, they are often reluctant to pay out claims. For instance, if the benefit is $6,000 per month, The Hartford would have to pay $72,000 annually.
Given the financial implications, it is not surprising that insurance companies prioritize profits over claim payments.
However, your plan administrator has a fiduciary duty to act in the best interests of all plan beneficiaries, including you. Despite this obligation, when faced with your best interest versus paying a significant claim, insurance companies may choose to deny it.
The Hartford must fully and fairly consider your claim. If they fail to do so, your only option may be to file a complaint in federal district court. This stage is complex, and having a skilled lawyer who can effectively communicate in writing is critical.
