When a long-term disability appeal is unsuccessful, the next step is to file a lawsuit. However, these claims are unlike other types of lawsuits because employee benefits such as long-term disability policies are governed by the Employee Retirement Income Security Act (ERISA), which strictly controls the process and remedies available to claimants. Ideally, you are already working with an attorney when your appeal is denied, but whether you are or not, you absolutely need one at this stage. At Gibbons Law Group, our disability attorneys have successfully navigated the ERISA legal process for many clients, and we can help you too.
ERISA Favors Employers and Insurers
If your long-term disability insurance was provided by your employer, the appeal and litigation processes will be governed by ERISA. In addition to a restrictive appeal process, ERISA also controls how lawsuits are handled and limits your options as a plaintiff. Unlike non-ERISA litigation over employee benefits, an ERISA lawsuit:
- Happens in federal court. ERISA is federal law; therefore, court proceedings regarding wrongful denial of benefits are handled in federal court.
- Pre-empts state law. A particular state’s laws about employee rights, fraud, breach of contract, bad faith, etc., will not apply to ERISA claims. An experienced LTD attorney will know this and will not pursue action based on state law.
- Restricts damages. Punitive damages and damages for pain and suffering are not available under ERISA. If your lawsuit is successful, you are limited to recovering the amount of the benefit due under the terms of the plan and, potentially, attorney fees.
- Does not involve a jury. Rather than a jury trial, an ERISA lawsuit involves a court review of the administrative record. This means that a judge will review all of the documents submitted during the claim and appeal processes to determine if the decision to deny benefits was reasonable.
- Limits new evidence. No new evidence can be submitted at the lawsuit stage, so you cannot submit more medical records or additional proof of your disability for the judge to review. It is vital that all relevant information be submitted with the initial claim or during the appeal process.
While ERISA favors employers and insurance companies, there are some—very limited—protections for LTD plan participants under ERISA, including disclosure obligations and response requirements on the part of the employer or insurer. An experienced ERISA attorney will hold the insurer to these requirements to help your case.
Clearly, lawsuits for wrongful denial of long-term disability under ERISA follow a unique legal process, and you need an attorney who has spent years handling ERISA cases and is committed to disability law. A lawyer in general practice, or one who typically handles things like Social Security disability, will not have the necessary insight to proceed successfully—neither will you if you choose to try to go it alone. These lawsuits are difficult to win, and you need experience and a record of success on your side.
The Sooner You Call Us, the Better
We understand that it’s not always easy to make the decision to call a lawyer when your LTD benefits have been denied. After all, lawyers cost money, and your employer or insurer is probably assuring you that you don’t need one. However, if you are unable to work and need your long-term disability benefits in order to maintain your quality of life, it’s vital that you not waste too much time deciding to hire a lawyer to help you. When we work with clients starting at the appeal stage, we understand that no new evidence will be allowed at the next stage, so we ensure that your administrative record is full and complete. This way, we are prepared if it becomes necessary to file a lawsuit.
You need your LTD benefits to get back on your feet. Don’t waste time trying to file your own appeal or working with a less-experienced attorney. Contact us today so we can get started right away.