ERISA long term disability cases are extremely complex.  To help you begin to make sense of it,  below is an introduction to ten things that you need to know if your long term disability carrier has denied benefits.

Are you feeling surprised or scared because your insurance company denied your disability benefits claim? Are you wondering why they think you’re lying or not hurt badly enough to qualify for benefits? Insurance companies have a tendency to approve the easy claims, like severe car accidents. But, they fail to help people like you whose injuries or condition might be subjective or not be visible from the outside. Don’t worry, we know how you’re feeling, and we want to offer as much help as we can. 

Here are 10 things to keep in mind about ERISA disability cases:

1. ERISA stands for the Employee Retirement Income Security Act. The federal labor law was signed by President Gerald Ford in 1974 to offer protection to working America and their pension funds. It was originally intended to make sure that qualifying participants receive their pension benefits. ERISA is supposed to hold disability insurance companies to a certain standard of accountability, however, the law unfortunately still heavily favors the insurance companies. ERISA does give you the right to appeal your case, and if you lose the appeal, you can take your case to federal court and sue. (But you are still stuck with only being able to use what went into your appeal, which is a huge obstacle in the absence of a very strong appeal).
2. Insurance companies are supposed to be there to help you, but that’s not always the case. They exist to make a profit, and that’s what comes first in many disability cases. Instead of looking into your case to help you, they are often looking for ways to deny your claim. They are quick to send out denial letters, but don’t let that stop you. You have rights.
3. Unfortunately, the laws are often not in favor of the injured party in long-term disability cases under ERISA. There are many factors stacked against you, and it’s a long battle. There is usually only one shot at an appeal, there are very strict deadlines, and your appeal gets sent to the insurance company that denied you in the first place. All of these things can be very frustrating, but you shouldn’t give up! 
4. Are you second-guessing whether your long-term disability benefits were wrongfully denied? If you feel like you have a valid claim, you really can’t work, and you have a doctor’s support, you need to find a lawyer that can review the medical facts of your case against what your insurance policy says. What your doctor has to say is very important to this review. If the insurance company made the wrong call, your lawyer should file an appeal. Don’t go to your doctor for this. They are not trained to write legal appeals.
5. You only have 180 days from the date you received your denial letter to do anything about it. Don’t try to handle an appeal on your own. If you do, and your appeal gets denied, it will be very hard to find a lawyer who will take your case. It will be way more expensive to do it that way.
6. Yes, you will have to pay your lawyer a portion of your benefits, often 1/3. But, if you do nothing or try appealing on your own, you’re most likely to get zero benefits. Isn’t ⅔ of the benefits better than nothing?
7. You should educate yourself by reading your entire insurance policy. Look to see if it includes any of these “bad news” phrases: we have the “discretion to determine benefits;” we pay only if you cannot perform “each and every” material duty of your occupation; we provide “own occupation” protection for less than two years; we provide income protection of less than “60% of prior earnings;” we will terminate benefits if you are “able to work part time” but do not; we set limitations on or refuse to pay for “self-reported symptoms.”
8. Request your own copy of your medical records. This allows you to read through them and possibly catch any errors before sending them off to the insurance company. If you see anything, then you can work with your doctor to make sure the records support your disability status.
9. If you’ve already received a denial letter, you can mail or email your letter to us for a free review and a free strategy letter. We will tell you what we find and what you should focus on for an appeal. We also tell you how we can help, if you choose to hire us.
10.  If you get a disability benefits denial letter, don’t get frustrated and do nothing. If you’re reading this, you’re on the right path. Just keep going, don’t give up. Take things one day at a time. You are in control, and you get to decide how far you want to take things. Just know that you do have options, and we’re happy to help in any way we can!

We want you to have all the information you need to decide if filing an appeal is right for you. Our book, “Finding the Devil: In the Details of Your Disability Denial,” has all the answers you need. Download your free copy now. We are happy to have our attorney, Carol Cadiz, review your denial letter at no charge -as a preliminary first step in offering assistance.