You and your employer may have paid for disability insurance benefits that are supposed to provide you with economic security if you
become disabled during the time you are employed. Unfortunately, while the insurance companies that issue these policies like to collect the premiums, they are not happy about paying legitimate claims.
An insurance policy is a contract. Enforcement of your rights requires understanding of the contract governing your policy – including the definition of disability, applicable deadlines for submitting claims and supporting evidence, and appeals procedures.
Too often, private insurers base decisions on incomplete medical information, relying on opinions from doctors in their employ who briefly review your application and records and then dismiss the evidence of your disabling impairment.
Many ERISA claims end up in court because of the insurance company’s stubbornness. It is important to you to be aware of the time within which claims, appeals, and (if necessary) lawsuits against the insurer must be filed. A missed deadline will be crucial. Equally important is the need to present all available medical evidence, treating physician opinion, and other relevant information to the insurance company while it is considering your claim. Failure to do this can result in the evidence not being considered by the court. Judges are limited to deciding whether the insurer made a proper decision given the evidence it had to review. The burden is on the applicant to be certain that the insurance company has all of the medical evidence.
On ERISA claims we work with applicants to improve the chances of a favorable decision without the need to sue the insurance company – and to increase the chances that if your claim is denied by the company after all internal appeals are exhausted, that a court has before it sufficient evidence to decide that the insurer failed to issue a reasonable decision.
Your job is to take care of yourself – ours is to deal with the insurer. Those large insurance company buildings and the generous salaries are paid for with policyholders’ premiums. The company would much rather collect your payments than to pay you. They have a large staff dedicated to denying ERISA claims. You should have competent help on your side.