When you file a long-term disability claim, your insurance company has its own motivations. It can even deny your claim in many cases. Legal help is a must when you need to appeal a denial, and a lawyer can ensure you get your benefits granted in the first place. Houma Long-Term Disability Lawyer provides clients like you with commonsense and dedicated legal representation when you have an ERISA long-term disability claim. Our firm brings more than 25 years of disability and injury law experience to bat in every claim, and we regularly obtain high-value settlements and verdicts, some exceeding $1,000,000. Never wait to reach out to learn more about our services and how we can help clients with disabilities in the Houma area.
Table of Contents
- How to File a Strong Initial Claim?
- Consider Legal Help at the Outset
- Why Insurance Companies Deny ERISA Claims?
- You Have Appeal Rights if They Deny Your Claim
- You Must Fully Participate in Appealing to the Insurance Company
- Call a Houma ERISA Long-Term Disability Lawyer at J. Price McNamara ERISA Insurance Claim Attorney
How to File a Strong Initial Claim?There are keys to filing the best initial claim possible. You must pay close attention before you file because a small error or hole in your claim can force you to the appeals process and add time and hassle to your disability claim. It can even jeopardize whether you get benefits at all. Here are some things that you should do when filing your initial ERISA long-term disability claim:
- Familiarize yourself with the language of your disability policy
- Review each of the required parts of your application (employee statement, employer statement, physician’s statement) and understand the expectations
- Take the time to review all of the necessary paperwork
- Create a robust medical record in support of your disability claim because this will form the basis for the insurance company’s decision
- Make sure to remain organized throughout the process
Consider Legal Help at the OutsetYou may also want to hire a lawyer to prepare and submit your initial claim application. Our experienced ERISA long-term disability attorney can help you build a strong claim and avoid mistakes that can result in a denial of your benefits. We have seen many claims over the years. We know what insurance companies look for and what pitfalls to avoid. Once you submit the claim, an insurance company has 45 days to review it. They may ask for a 30-day extension in certain circumstances. You will get a relatively quick answer when the insurance company has granted or denied your claim. It is often difficult to predict whether you will be initially successful. It can come down to the person reviewing your claim. One person at the insurance company may grant benefits, while another can deny them.
Why Insurance Companies Deny ERISA Claims?The two most common reasons for the denial of benefits are:
- Your claim did not meet the policy’s definition of disability - Each policy has a different definition of "disability." Insurance companies like to play games with their definitions of terms. They may, for example, unreasonably narrow the reading of the term, contrary to the policy's language, to deny your claim.
- Your medical records did not support your claim of disability - An insurance company will closely review the medical justification for your claim. They will usually not give any deference to your treating doctor's statement. The insurance company will have its own doctors review your medical evidence and have their own opinion of whether you should receive benefits. They may not think that you are unable to work and eligible for benefits. Another thing that the insurance company may claim after reviewing your medical records is that your condition was pre-existing. You cannot receive disability benefits for a pre-existing condition.
You Have Appeal Rights if They Deny Your ClaimThe first step of the appeals process is to file an appeal with the insurance company itself. If this does not seem like it works in your interests, your thought pattern is correct. The same insurance company that said no to your initial claim for benefits is now deciding whether they made an error in denying your claim. Of course, it is always possible to add information to your claim that addresses the insurance company’s concerns. You can win at the initial stage of the appeal and reverse the denial. Generally, the insurance company will give the appeal to a different reviewer than the one who initially rejected your claim. The new reviewer will critically look at your case and the initial denial. In practice, this sometimes happens, but you often cannot trust an insurance company to make decisions that benefit anyone but itself.
You Must Fully Participate in Appealing to the Insurance CompanyNonetheless, you must expend all effort possible at the insurance company phase of your appeal. Often, your real audience is the federal judge who may hear your case because that is where you can go next if you lose your appeal to the insurance company. The district court judge will review the same record that you put before the insurance company. In fact, the law states that you cannot add to that record if your case goes to federal court. This limitation is precisely why you need to pull out all the stops to appeal to the insurance company, even if you do not think they will be objective and fair. The federal judge will review the insurance company’s decision to see if it was right. Depending on the language of your policy, they may even take a fresh look at the record, not considering the point of view that the insurance company expressed when denying your appeal. In other cases, they may look to see whether the insurance company made a reasonable decision in denying your appeal. Regardless of how the court looks at your appeal, you can expect that a judge will give thorough consideration to your arguments of why you deserve benefits. Even if you do not win your case at the district court level, you have further rights. You can appeal that decision to a federal appeals court. The appeals court can reverse the decision if they think that the district court made a mistake. If that happens, they may send the case back to the district court level to reconsider it. The appeals court is only looking at the decision of the district court judge to see if they made an error. It would be highly unusual for the Supreme Court to wade into an ERISA appeal unless they see a critical issue that they need to address.
Filing Your Strongest Appeal PossibleHere are some things to consider when filing an ERISA appeal:
- The first thing to do is call an experienced attorney
- Closely review the reason for the insurance company’s decision and their supporting documentation - it can give you the roadmap for success in your appeal
- Take the time you need to be thorough and not rush the appeal, even though you may find yourself in a difficult financial position
- Know that you are in a fight with an insurance company that is prepared to go the distance to avoid writing you a check
Houma Long-Term Disability FAQsHere are the answers to some questions commonly asked about ERISA long-term disability claims and appeals
What chance do I have of winning my ERISA long-term disability appeal?We cannot put a number on your percentage chance of winning your case. We can say that if the insurance company made a mistake, we will find it, argue your case, and make sure to hammer that point home. If the judge sees that the insurance company made an error, they will reverse the denial and grant you benefits. You do not know whether you can win your appeal until you try to file one.
Do I need to have an ERISA disability attorney?You are certainly better off if you have an experienced attorney handling your claim. You only have one chance to build a record for an appeal, and you do not want to waste the opportunity. One of the biggest mistakes that a claimant can make is handling the insurance company appeal on their own and getting an attorney when they lose. The case is essentially over because you do not have a strong enough record to take to the judge.
Can I sue the insurance company for rejecting my claim?One of the challenging parts of ERISA law is that you cannot sue your insurance companies for bad faith for rejecting your claim. It gives them a lot of flexibility to use their usual tricks in denying your claim. However, recent rule changes have allowed people the right to sue the insurance company directly if they do not follow specific procedural rules regarding your claim. In addition, insurance companies must be free from conflicts of interest when reviewing your claim. The government can punish insurance companies for dubious schemes that they have used in denying mass numbers of claims. Even after you have received benefits, you may still need an ERISA long-term disability lawyer. Insurance companies will try to change the rules even after they grant your benefits. To rescind your benefits, they may try to tighten and adjust the policy’s definition of “disability” to revoke your benefits. There have been plenty of examples of insurance companies that have attempted to cut off benefits after granting them. Like an initial denial of your claim, you can fight this determination. You can always count on an insurance company to do what it feels is best for its bottom line.
Call a Houma ERISA Long-Term Disability Lawyer at J. Price McNamara ERISA Insurance Claim AttorneyFor help with your ERISA long-term disability claim, contact J. Price McNamara ERISA Insurance Claim Attorney. We have a long track record of getting results for our clients in the face of insurance company resistance. Reach out to us online or call us at (225) 201-8311 for your free initial consultation. ERISA law is complex, dealing with complicated medical issues. Do not take chances with the disability benefits that you need.
This has been a very difficult time for myself and my family. Mr. Mcnamara did his best to be as empathetic and compassionate as possible. He is very knowledgeable and a man of great integrity. Nicole