An Ocala FL ERISA Attorney Can Help You With Your Claim or Appeal
We understand how daunting a disability insurance claim can be when you’re not represented by an ERISA attorney. You’re dealing with conflicting information from the insurance adjuster, you’re constantly filling out forms, and you’re pretty sure that a private investigator is tracking your activity. Then, you get a denial letter. While you may feel like giving up, you have options. An experienced ERISA attorney at CJ Henry Law Firm can help.
Am I Disabled Under ERISA?
Each disability insurance plan has its own definition of disability. Before you can assess your eligibility for either long term or short term disability insurance benefits, you need to review your plan documents. An ERISA attorney can help you obtain and understand the complicated and highly technical information contained in your plan’s summary plan description (SPD) and plan document.
Generally speaking, you will have to show that you are either unable to perform your “own occupation” or “any occupation” for an extended period of time. While this might sound simple, it’s actually a complicated analysis. Your ERISA attorney might:
- Review your medical records and the opinions of your doctors, documenting your diagnoses, limitations, and your likelihood of making a physical or emotional recovery
- Assess your education, work history, job duties, and other factors that might impact your ability to obtain a job
- Consult with medical and vocational experts that can provide insight into your claim
- Assess the disability insurance plan’s exclusions, exceptions, and claim procedures
- File detailed written arguments and evidence that supports your claim
If you’d like to learn about ERISA disability claims and your eligibility, contact CJ Henry Law Firm for a free consultation.
What Is the Employee Retirement Income Security Act (ERISA)?
The Employee Retirement Income Security Act of 1974 (ERISA) regulates all employer-funded benefit programs. This includes employee benefits such as:
- Healthcare insurance plans
- Disability insurance plans
- Employer-sponsored life insurance
- Accidental death and dismemberment coverage
- Other insurance plans and benefits
When ERISA covers an insurance plan, the company and its representatives must follow certain policies and procedures. The law also controls the claims and appeals processes.
How Can an Attorney Help You Appeal a Denied Claim?
It’s important to understand that claims under ERISA are handled very differently than other insurance claims (like those involving car crashes). If you disagree with an insurance company’s denial of benefits you must follow a two-step appeal process.
- Administrative appeal: the insurance company must review your claim again, assess any additional information you submit, and issue another decision. At this stage, you can submit as much evidence as you want that supports your claim.
- Federal lawsuit: after the administrative appeal process is complete, you can file a lawsuit in federal court. However, the judge will not consider any newly-provided evidence that you try to submit. Instead, they will consider whether the insurance company violated certain standards, based on the information in your insurance company case file (sometimes called your “administrative record”).
Both appeals have their own filing deadlines and other requirements as well. An ERISA attorney can make sure that you don’t miss anything that could be detrimental to your appeal.
Because you can’t submit new evidence during a federal court appeal, it’s vital that you get legal assistance early on. Unfortunately, some insurance adjusters discourage disabled workers and their families from consulting with an ERISA attorney. Even if the adjuster or claims representative seems pleasant, they are not on your side. And if you wait too long to speak with an experienced lawyer, you might lose your right to disability insurance benefits.
Disabled Workers Deserve Honest Advice and Tireless Advocacy
The sooner you retain an experienced ERISA attorney, the sooner they can start reviewing your claim, stacking your administrative record with supporting evidence and building a comprehensive disability claim strategy for you and your loved ones.
At the CJ Henry Law Firm, we’ve built a strong reputation for ERISA advocacy. Our team offers a unique combination of both legal and medical experience that we put to use for our clients and their families. We understand the complexities of both administrative and federal ERISA appeals and help our clients fully understand their legal options. To request a free, no-risk evaluation, contact us today.
Speak With an ERISA Attorney at CJ Henry Law Firm
It’s time to stand up to the insurance company and demand the benefits that you deserve. An ERISA attorney at CJ Henry Law Firm can help. Our experienced team of professionals carefully studies each and every case we handle and fights for the benefits that our clients need to survive. We also give our clients the practical advice, respect, and compassion that they deserve during a difficult time. If you’d like to learn more about our approach to ERISA disability insurance claims, contact us today.