Why Do Insurers Deny Long-Term Disability Claims?
Insurers deny claims for a variety of reasons. It could be because they failed to receive the documents needed to make the decision within the regulatory timeframe. It may be because you failed to cooperate with them, like not attending a scheduled exam. It might be because the evidence does not support your claim or your condition is excluded from coverage under the policy. It may also be that they simply don’t want to pay. They might have recognized that your case will cost hundreds of thousands of dollars, so they deny or terminate your claim….Read More
Does ERISA Govern How Employers Must Handle All Employee Benefits, From The Frontline Workers All The Way Up To CEOs?
ERISA provides a uniform minimum standard to ensure that employee benefit plans are established and maintained in a fair and financially-sound manner. While ERISA does not require an employer to provide a benefit plan, if an employer chooses to do so, they have an obligation to provide promised benefits and satisfy ERISA requirements for managing and administering the plan. This applies to how they handle all employee benefits from the frontline worker all the way up to the CEO…Read More
What Will The Claim Administrator Do To Investigate The Claim?
The insurance carrier can obtain your medical records, conduct a phone or an in-person interview with you, and conduct surveillance of your activities, both online and in person. Social media is one of the biggest ways they can conduct an investigation without even leaving their office. They can also send you to their doctor for a medical exam…Read More
How Does The Department Of Labor Enforce ERISA?
The regulations of an employee benefit plan are enforced through the Internal Revenue Code and ERISA. The two agencies that share responsibility for enforcing ERISA are the IRS and the EBSA, also known as the Employee Benefits Security Administration. Active enforcement activities include investigations, lawsuits, and the dissemination of information. Documents published by EBSA include the Reporting and Disclosure Guide for Employee Benefit Plans…Read More
What Are Possible Reasons To Sue A Plan Or Fiduciary Under ERISA?
The ERISA statute does have a civil enforcement scheme, which permits claimants to go to court. One cause of action under ERISA is a claim for benefits, which is frequently seen in long-term disability situations. There could be claims for breach of fiduciary duty, if the administrator failed to do something or did something that was not in the best interests of the plan. There could be a COBRA violation, if there is an issue with the health insurance plan, or a violation of the Anti-Interference or Anti-Retaliation Act provisions of ERISA, if you were retaliated against…Read More
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