Dealing with an injury or illness is something no worker welcomes. Unfortunately, life happens and sometimes we find ourselves dealing with the unexpected.
Some people are fortunate enough to have disability insurance with their employer to assist them in the unfortunate event of illness or injury. While this can be a great comfort, it is not always administered in practice according to the wishes of someone who finds themselves newly disabled. Too often, valid claims by an employee on an employer sponsored policy are denied.
In these cases, Homan & Zentz, P.C. can help.
Benefits offered by most employers are governed by the Employee Retirement Income Security Act of 1974 (ERISA). ERISA is a very technical statute that has many requirements for employee benefits.
In the case of long term disability (LTD), the insurance company has significant discretion in deciding the validity of the claim.
Denial and Appeal
Claimants for LTD benefits rightly expect that their claim will be processed and paid quickly. Many don't realize that as part of their claim, their plan will require them to apply for Social Security benefits as well. Both of these processes can take a lot of time and be very stressful.
With respect to the LTD claims, the insurance company has the initial discretion whether or not to pay your claim. If they do not, they also are the source of your first appeal. Denials from the insurance company must be appealed to that same insurance company.
While these appeals are not in front of a judge, handling these appeals is VERY important. In the event your claim does end up in court, how the appeal is handled may impact your ability to be successful in Court. What the court may consider in an ERISA case is very different from other types of claims. It is important to contact a lawyer to assist you in the appeals process. Homan & Zentz, P.C. can assist you with this appeal.
If your appeal is denied by the insurance company they are required to inform you why and inform you of your right to file a lawsuit for your benefits under ERISA. At this point, you will need the guidance of an experienced ERISA attorney to review your claim, the appeal, and advise you on how to proceed in federal court. Call Homan & Zentz, P.C. immediately to discuss your options.