The long-term disability benefits that employers offer are a crucial but often overlooked benefit.
Long-term disability benefits help you weather periods when your health interferes with your ability to perform your employment’s material duties. While such stints are hopefully short, the average long-term disability benefit potentially provides coverage through an employee’s retirement age.
To provide this benefit, many employers turn to insurance companies as the decider of whether you – the unhealthy or injured employee – can perform the material duties of your job and/or any gainful employment. That same insurance company is also often the payer of your long-term disability benefits. This inherent conflict of interest often leads to a wrongful denial of benefits.
Appealing an Insurance Denial
Just because an insurance company has decided that you do not meet the definition of disability does not mean you are not entitled to benefits.
Like all employee benefits, long-term disability benefits are governed by the federal laws of ERISA. The regulations require insurance companies to provide an internal appeal process for a review of wrongful denial of a long-term disability benefit.
You are also allowed to file suit against the insurance company for wrongful denial and breaches of fiduciary duties if you are unsuccessful during the internal appeal.
Ensuring Your Rights Under ERISA
In addition to the rights of an internal appeal and the private course of action to sue, the ERISA law and regulations require strict guidelines and limitations for what a court can consider when reviewing a denial. Those requirements are both a hindrance and a help to you, the wrongfully denied party.
To fully benefit from ERISA protections and avoid the common pitfalls, it is important to retain counsel with years of experience in ERISA litigation to assist in the appeal of your wrongful denial of benefits and pursue a cause of action. In most cases, a favorable outcome at court depends upon knowing if the insurance company followed the regulations of ERISA during the internal appeal.
Because of our understanding of the regulations, the ERISA litigation lawyers at Gallagher Davis, LLP know what insurance companies can and cannot do and how to utilize an insurance company’s mistakes or errors to the benefits of our clients.
Beyond understanding what is required under the federal regulations, the ERISA litigation lawyers at Gallagher Davis, LLP also know what information the insurance companies need from your physician and how to guarantee that your physician will produce it.
Many times, the insurance adjusters, who are not physicians or medical experts, are looking for specific details from a medical provider. That language is often not what a physician would necessarily produce as part of care or an examination.
It is also common for physicians to refuse to complete and submit information related to long-term disability claims. Along with knowing what information the insurance company needs, the ERISA litigation lawyers at Gallagher Davis, LLP can help in obtaining necessary information from non-cooperative physicians.
Knowing what an insurance company needs and how to get a physician to provide it is almost as valuable as knowing the ins and outs of ERISA law. By routinely interpreting a physician’s language into that of the insurance company’s, we successfully appeal wrongful denials of long-term disability benefits.
Lawyers for ERISA & Employee Benefit Litigation: Contact Us Today
The seasoned ERISA lawyers at Gallagher Davis support you in cases of wrongful denial of long-term disability benefits.
With experience in all state and federal trial and appellate courts in the St. Louis metropolitan area, as well as federal courts throughout Missouri and the Midwest, our attorneys for long-term disability provide you with vigorous advocacy and representation in justly receiving employee benefits to which you are entitled.
If you have confronted a wrongful denial of long-term disability benefits, contact us at (314) 725-1780 to discuss whether you have a cause of action or if we can help you file an internal appeal of the denial.