Long-Term Disability Benefits Denial
If you have purchased a long-term disability plan, or had such coverage provided to you by your employer as part of a benefits package, you are entitled to long-term disability benefits if you become disabled.
If your claim for long-term disability (LTD) benefits has been denied, you have the right to appeal such a long-term disability benefits denial. My firm can help you fight to recover LTD benefits that have been wrongfully denied. It is important that you retain an attorney as soon as possible after the denial, as disability insurance claims are usually governed by ERISA, and strict appeal deadlines apply.
ERISA (Employee Retirement Income Security Act of 1974) is federal legislation designed to protect retirement plans and pensions of U.S. workers. While this was its primary goal, it also resulted in granting partial immunity to insurance companies that handle disability insurance claims.
For ERISA-based policies, once internal appeals have been exhausted and a lawsuit has been filed, no more evidence may be submitted. The court then conducts a “judicial review of the administrative record.” There are no hearings or trials and, generally, neither the claimant nor the treating physician(s) may testify. Instead, the court reviews the medical reports and records already in the claim file. Under ERISA, federal courts are to defer to the insurance company’s decision (i.e., their denial) so long as there is a rational basis and reasoned explanation for the decision. A court will only overturn the insurance company’s denial if the claimant shows that the denial was “arbitrary and capricious.” Further, in ERISA-based claims, the claimant can only recover the disability benefits owed and in rare cases, attorney’s fees are awarded. ERISA laws do not allow you to recover consequential or punitive damages.
If the disability policy is not governed by ERISA (i.e., you are either a governmental or church employee, or you purchased an individual disability policy for which you paid the premiums, as opposed to an employer-based plan), you are in a much stronger position. In court, you must show you are disabled by the preponderance of the evidence. However, you may call witnesses, including yourself and your treating doctors, to testify at a trial by jury.
My Office Can Help You With Your LTD Claim; Call For Free Consultation
Whether your LTD policy is part of an employer-sponsored plan governed by ERISA, a group plan or an individual LTD policy, I can provide legal support in Louisville and throughout Kentucky. If you, a family member or a friend has been denied LTD benefits, please call 502-309-3636 or contact me online as soon as possible after the denial, so I may review your case.