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Athens Long Term Disability Lawyer

Athens Long Term Disability Lawyer

The Employee Retirement Income Security Act (ERISA), while designed to protect employees’ access to disability, is a complex federal law which allows an employee to pursue a claim if an employer’s insurance company refuses to pay out on a claim under the employer’s policy. Although originally designed to protect your rights, over time, lobbying efforts from insurance companies have made it more difficult to obtain benefits under the law.

This means that anyone filing for benefits, or appealing a denial or termination of benefits, should work with an experienced ERISA attorney to appeal that negative outcome. It is especially important to include all relevant evidence to your claim up-front in case you do have to file an appeal, as no new evidence can be admitted if you do go to court.

At the Law Offices of J. Price McNamara, we regularly handle ERISA disability litigation on behalf of our Alabama clients. Contact us today to find out more about our services.

Your Rights Under ERISA

ERISA provides claimants with the following rights:

  • If benefits are denied or terminated, claimants must be provided with copies of any and all documents relevant to the claim;
  • If denied, claimants are allowed at least 180 days to file an appeal;
  • If a claimant files an appeal, the insurer must make a determination within 45 days of receiving the appeal. However, if special circumstances exist, the insurer must notify the claimant that up to an additional 45 days is needed. After 90 days, a determination is required; and
  • The right to file a civil action in federal court under §502(a) after filing two appeals (within internal appeals process insurer sets forth).

Tactics Insurance Companies Use to Deny Claims

These are some of the common reasons your insurance policy will deny your application:

  • Your disability does not fit the insurer’s definition of disability:
  • You are not yet eligible to receive long term disability benefits because you are still in the “elimination period” and must first use up all of your short-term disability and sick time before filing for long term disability;
  • You did not also file for Social Security Disability Insurance benefits;
  • You provided insufficient medical evidence;
  • Your doctor’s statement was insufficient;
  • The insurance company’s medical expert disagrees with your doctor; and/or
  • You missed the appeal deadline (most plans provide you with 180 days to appeal).

Exemptions

Keep in mind that, not only does Alabama not mandate that employers carry long term disability insurance, church benefit plans—as well as those of local, state, and federal government employers—may be exempt. This is because ERISA was designed to protect employees covered by private insurance plans, and public employees may already have protections like these in place.

Contact Us for a Free Consultation

Our ERISA disability insurance attorneys offer free consultation and information for individuals at all stages of filing for long term disability. Contact us today with any questions you have. We answer all questions FREE OF CHARGE.

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