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ERISA Lawyer

Nationwide ERISA Disability Claim Attorney > Practice Areas > ERISA Lawyer

What is ERISA?

ERISA is shorthand for the Employer Retirement Income Security Act of 1994. It’s Federal legislation that governs how insurance companies handle disability claims and it gives disability carriers a “get out of jail free card.”

In most ERISA governed claims, a court can only overturn the long term disability carrier’s decision if you prove that the denial was “arbitrary and capricious.” That’s the highest burden of proof in a civil court and it’s the “get out of jail free card” that disability insurance companies, like UNUM Provident, MetLife, Cigna/LINA, Aetna, Lincoln Financial, Prudential and The Hartford use to “play hardball.”

Claims denial and appeal

If your long term disability claim has been denied or terminated, the ERISA rules provide that you’ll have 180 days in which to file an appeal. You should request a copy of your complete file from the long term disability carrier and hire an experienced long term disability attorney to represent you in the appeals process.

Once the appeal letter is submitted under the ERISA statute, the long term disability carrier will have 90 days in which to review the material and decide whether it’s going to overturn or uphold the denial.

View More About The Claims Denial and Appeal Process


Filing the law suit

Once the internal appeals process is exhausted, you’ll have the right to file a lawsuit in Federal court. However, no additional evidence can be submitted. The Judge is limited to reviewing the claims file. There are no depositions, hearings or even trials. That means that neither you or your treating physician is going to be able to testify.

The court will simply review the medical and vocational proof in the claims file. The appeals letter is, quite frankly, your trial and that’s why it’s crucial that you have an experienced disability attorney represent you in the appeals process.

How the Federal Judge makes a decision in an ERISA case

In most ERISA governed cases, the Federal court must defer to the long term disability decision so long as there is a “rational basis” or a “reasoned explanation for the decision.”

The Federal court will only overturn the insurance company’s denial, if you can show the denial is “arbitrary and capricious.” Even if you’ve been accepted as being disabled by the Social Security Administration, the long term disability carrier isn’t bound by that determination. The discretionary clause in the disability insurance company is their “get out of jail free card.”

When you file a lawsuit the best you can hope for is to recover the past due benefits that you are owned and have your monthly disability check reinstated. Unfortunately, there are no bad faith or punitive damages and attorney fees are rarely awarded. Most cases settle for 10% to 50% of the past and future value of your benefits.

What you should do today

Let’s be frank. Long term disability insurance claims are complicated. There are short deadlines and the appeal is your trial. There are a number of legal issues in many appeals including limitations, benefits due to mental illness or self reported conditions, exclusions for pre-existing conditions and even arguments about overpayments or reduction of benefits.

You would owe it to yourself to get help with your long term disability claim, appeal or lawsuit regardless of whether or not your long term disability policy is a group sponsored long term disability plan or an individual disability income policy.

Contact long term disability attorney, Nancy Cavey, who has helped hundreds of people with the long term disability insurance. She’ll personally consult with you, review your claim, prepare your appeal, and if necessary, file suit and represent you in court.

You purchased a long term disability policy to provide you with peace of mind. But, when you least can afford it, your disability carrier has denied your benefits and has rejected your appeal.

Your next and only recourse is to hire an ERISA/long term disability attorney to sue your long term disability carrier. Your attorney will file what is called a complaint which outlines the facts of your case and why you are entitled to benefits. There generally is no activity for 60 to 90 days after a claim is filed. Why? The complaint is filed and then served on a defendant who, in turn, has to “answer” the complaint within 20 erisa lawsuitdays after the lawsuit is filed.

Their “answer” is nothing more than the formal denial of the allegations of the complaint.

After the answer is filed, the court will issue a scheduling conference order directing the attorneys to confer about the scheduling of events in your case including, taking depositions, disclosing experts, filing motions, mediation, pretrial and trial.

The scheduling conference takes place about two to three months after the law suit is filed and establishes a time table for the parties to complete the discovery, conduct mediation and have a trial date.

Each court has there own local rules. These dates might vary depending on where you live. In any event, it may seem that nothing is happening until the scheduling conference. And, quite frankly, that’s incorrect. Many ERISA long term disability attorneys are drafting what’s called interrogatories and requests to produce which they can file as soon as the scheduling conference order is issued.

Need Help With Your ERISA Lawsuit? Contact an ERISA Attorney

You can learn more about the ERISA mediation process by contacting ERISA disability attorney Nancy Cavey who can help you with your claim regardless of where you live in the United States.

A History on ERISA Disability Claims

The Employee Retirement Income Security Act of 1974 (ERISA) is a federal law that governs employer sponsored health, life, disability and pension benefits.

If you purchased disability insurance through your employer, union or trade association your benefits will be governed by ERISA. On the other hand, if you bought your policy on your own or your employer is or a church, your benefits are generally not subject to ERISA but is governed by state law.

ERISA was designed to protect employees. The reality is that ERISA and discretionary clauses in disability policy have become tools for disability carriers to delay or deny the payment of benefits. Disability carriers use the “Golden Rule” in handling claims. They collect your gold and rule that you are not entitled to benefits.

As Judge Enslen said in Zanny v. Kellogg Co. and Metropolitan Life Insurance Company., Case No. 4:05-CV-74, June 30, 2006:

“Metropolitan Life Insurance Company has arrived at a formula for operating a profitable insurance business. It simply does not allow piddling things like facts to intrude upon its employee benefit claim decisions.”

The ERISA law is complex and full of minefields for unwary policy holders and lawyers who have no experience in handling an ERISA case. Crucial mistakes can be made:

1. Before you stop working,

2. When you apply for benefits,

3. Dealing with a carrier’s request for information, independent medical examination or a functional capacity evaluation,

4. During an appeal of a claims denial or

5. Filing a lawsuit.

I have written the go to consumer guide Robbed of Your Peace of Mind: Everything You Need To Know About Your Long Term Disability Claimthat explains the unfair policy language you don’t want to see in your policy and the mistakes that can destroy your claim. You can order a free copy of this must read book by clicking here.    

Free Consultation by Nation Wide ERISA Disability Attorney

We can help you with health, life, disability and pension claims.  Call 727-894-3188, to set up a free 30 minute consultation, click on our chat live button or fill out our intake form. Don’t delay! You owe it to yourself and your family to get answers to your questions and the benefits you deserve.


What Does ERISA Do?

ERISA, an Employee Retirement Security Act enacted in 1974, requires employers to provide participants with information about the plan, plan funding and important features. This information is to be provided regularly and automatically. Information can be available free of charge or it can cost money.

ERISA also sets the standards for employers for benefit accrual and funding rules. It is defined by the law as when an employee becomes eligible to participate in a plan, accumulate benefits, and have a right for those benefits. The funding of plans is also controlled by the law.

ERISA also guarantees the payment of specific benefits if a plan is terminated through a federally charted corporation, also known as the PBGC (Pension Benefit Guaranty Corp). Handling ERISA cases is our specialty and our knowledge allows us to serve our clients professionally and courteously. Our goal is to provide you with quality legal counseling and have you rest assured while we handle you ERISA case.

What Does ERISA Stand For?

ERISA stands for “Employer Retirement Income Security Act.” It was passed in 1974 for the purpose of protecting employee benefits for group plan participants. Unfortunately, disability insurance policies are subject to the ERISA regulations, which long-term disability carriers refer to as “Everything Ridiculous in the World Since Adam.”

ERISA, which is a federal statute, pre-empts state law. That means that there are no state law causes of action, including bad-faith claims handling.