If you apply for disability through the insurance plan of your employer but were denied benefits, you still have options. The first step you need to take after a denial is to get a copy of the disability portion of your employer’s insurance plan. Most of these policies offered through employment are covered under Federal ERISA law. These laws require that before filing a lawsuit, you must appeal your denial internally with the insurance provider.
An experienced Tulsa, Oklahoma, ERISA attorney can help you determine what your timeline is for filing an appeal, but your plan should also explain the deadlines. Some plans specify a time limit of just 60 days, but most will allow up to 180 days to file an appeal after a denial. Some plans will even allow two appeals to be filed.
Although there are a variety of methods that may be used for settling an ERISA claim through the court, mediation and trials are two of the most common. Many long term disability claims that are ERISA-based will settle through settlement conferences or mediation. These confidential meetings do not have the strict rules of the court. If a settlement is reached in a conference or mediation, that means that both sides have ultimately agreed on a settlement amount. You are allowed to walk away from the settlement discussion at any point and can not be manipulated or forced to settle your claim. However, once they are settled, they are final and can not be appealed.
If a case does not settle, it will proceed to trial. The trial will be a bench trial that takes place in front of a judge but without a jury. The judge will review the records and make a court decision, not a settlement. This means you will either win or lose. If the judge finds in your favor, the insurer will be required to pay monthly benefits from that point forward as well as any back benefits. You may also be awarded attorney fees. The insurer may still require you to prove periodically that you are still disabled and may be able to terminate benefits at a later date. If the judge does not find in your favor, you may be able to file an appeal with the United State Court of Appeals.
Even if the Social Security Administration has approved disability benefits for you, the disability plan through your employer may still deny you benefits. This often happens because the definition of disabled is not always the same for an insurance company as it is for the SSA. It is that definition that will determine whether your employer’s plan will have to pay benefits for your specific situation.
ERISA laws can be complex and confusing so having legal representation on your side can help ensure that your rights are protected. The attorneys at the Law Offices of J. Price McNamara have years of experience helping their clients navigate the complex legal system. Contact our office today to schedule a consultation.
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