If a person becomes disabled and is unable to continue working, he or she may have a claim for disability benefits from a company plan. Our office has many years of experience with ERISA law and will be more than happy to talk with you about your claim.
Employers often offer employee benefits to their employees, such as short-term disability benefits, long-term disability benefits, health insurance, dental insurance, and life insurance.
Because short-term and long-term disability benefits are offered as employee benefits at work, these are regulated under a federal law called the Employee Retirement Income Security Act of 1974. These claims are commonly referred to as “ERISA Welfare Benefit Claims.” They are very different from other types of litigation and can have many pitfalls and traps for unrepresented claimants and even for lawyers who are unfamiliar with the ERISA procedural rules.
Generally, the ERISA short-term and long-term disability process involves two parts:
(1) The Administrative Process
The application and appeal of any denial of a claim for benefits is handled by submitting medical documentation, and the employer or employer’s insurance company decides the claim. After appeals end with what is called a “final” letter ending the Administrative Process, the next step is to proceed to Federal Court.
(2) Federal Court
A federal court judge is only permitted to look at the administrative record (what the employer or insurance company had at the time it denied the claim) to decide whether the employer/insurance company completely lost its way in coming to the decision to deny benefits.
The Administrative Process described above demands that all pertinent documentation concerning disability be furnished either to the employer or the insurance company, whomever decides whether the disability should be paid. Once that Administrative Process is closed with the “final” letter, no more documents can be added to the file, and the paperwork that has been submitted is called the “record.”
If a case then proceeds to Federal Court, the Federal Court only reviews the “record” and does not allow for any additional evidence in the Federal Court proceeding. Any federal action for employee benefits can only result in the payment of those benefits and no other compensation for inconvenience or other normal type damages that are included in civil lawsuits. The Court simply enforces the contract for the disability or health benefits, whichever is the case.
Anyone seeking short or long term benefits should consult an attorney to determine if representation is necessary. Contact us today for a free consultation.
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