You filed a disability benefits claim with your insurance company and received a denial. Then, you filed an appeal but your claim was denied again. Now you may be wondering, what are my options?
You can’t begin an ERISA lawsuit until you have exhausted all other claims appeals. This includes filing an administrative appeal and receiving a denial. Depending on your policy, you may have to file several administrative appeals or only one.
There is a deadline in which to file your lawsuit. This is often governed by your insurance policy, so check the terms carefully.
The most important step you can take is to hire a reputable Ocala FL disability attorney who is experienced with ERISA lawsuits. We can advocate for you and will recommend the best strategy based on your case.
In most cases, you’ll sue the insurance company instead of your employer. However, there are some circumstances when you may also sue your employer or the plan separately. Your attorney will discuss this with you.
Your attorney will file a summons and a complaint in Federal District Court. There is a deadline for serving documents to the defendant (your insurance company). It’s important to meet this deadline.
The defendant will file an answer addressing the allegations in your complaint. The insurance company can file a counterclaim about why they shouldn’t have to pay your claim. One argument they use is that you received additional income from a different source after you received disability benefits.
You and the defendant can come to a settlement without going to trial. Your attorney may decide to open settlement discussions and will submit an amount to the insurance company that is acceptable to you.
The insurance company usually reviews the settlement demand and returns with a counteroffer. You can be sure the counteroffer will be less than the amount your attorney requested. This exchange may be repeated several times.
There are several factors that influence whether or not you’ll be able to reach a settlement including your goal for filing the lawsuit, the strength of your claim, and the insurance company’s willingness to enter the settlement discussions in good faith.
If you can’t reach a settlement, another option is to try mediation. A third party will act as a liaison between you and the insurance company. They may offer suggestions which may help everyone reach an agreement. However, mediation is not a requirement.
If there is no settlement before going to court, both parties begin the discovery process. This stage happens before your claim goes to trial. Your lawyer asks the defendant to provide information and documentation relative to your case. They may also interview individuals from the insurance company or call on an expert witness.
The attorney for the insurance company will review the discovery demands and will likely have objections which delay going to court and results in more discussions. Your attorney will advocate for you against any objections the defendant may raise. Sometimes objections to discovery demands can be settled without involving the court.
Any time during or after discovery either you or the insurance company can request a summary judgment. This is a motion asking the judge to make a decision based on the facts both parties agree to without going through a trial.
It is not surprising that your attorney will argue that the judgment is in your favor and the opposing attorney will argue the judge should decide in their favor. The judge may decide in favor of one party or he or she may deny the motions from both parties. If that happens, the case will go to trial.
It is much easier if the parties are able to reach a settlement before going to court, but that doesn’t always happen. Preparing for the trial is tedious work requiring hours of work on briefs, arguments, and filing additional motions or other information.
After the trial, the judge will give his or her final order and decision. You may be granted all or part of your claim or your claim may be denied. If you are not awarded your total claim, there are options for further appeal.
At CJ Henry Law Firm, PLLC, we have years of experience litigating ERISA cases. Learn more about how we can help by contacting our Ocala FL office today.