Group Disability Insurance & ERISA
With this type of disability claim, long-term coverage is provided through an employer group disability insurance policy or through an employer self-funded plan. The coverage is regulated by a federal law known as ERISA, which stands for Employee Retirement Income Security Act. This Federal Law governs most employer-sponsored disability insurance and life insurance plans. It has many strict procedures and deadlines which must be followed or your rights can be lost.
All ERISA claims have several things in common. They are most frequently litigated in Federal Court, a court in which most lawyers are uncomfortable. Before getting to court, there is an administrative appeal that you must follow. It is imperative that this appeal procedure is followed. If it is not, you will, in all likelihood, lose your right to sue the insurance company. If you wish, we can send you a brief summary of the appeal process and what you must do to make sure the appeal is properly prosecuted. All you have to do is email Attorney Shaffman and request it.
Unfortunately, ERISA law clearly favors insurance companies and falls short in protecting the rights of the disabled. For example, you are not entitled to have your case tried before a jury. Usually, a judge decides the case based upon the written evidence in the insurance company's file. Furthermore, you cannot get compensatory or punitive damages.
Although California has passed numerous regulations to keep insurance companies from acting in bad faith and wrongfully denying these types of claims, ERISA law more likely than not will preempt California law, thereby protecting and shielding the insurance company for their wrongful conduct.
ERISA claims are routinely lost because a claimant doesn't follow the proper rules and procedures. As a result, you should be aware of the following procedural rules/regulations regarding ERISA claims:
- You must complete the administrative process of your claim through the appeals process before you can file an action in court.
- Early consultation with an attorney allows him or her to make sure that your file (administrative record) contains the appropriate documents to prove your disability claim in court.
- The evidence that you are allowed to present in court is usually limited to the administrative record, so you cannot testify, nor can you have any witnesses testify to support your claim.
- ERISA regulations impose strict deadlines and procedural requirements that must be adhered to.
- At a minimum, the medical evidence in your administrative record should contain a certification from your treating doctors outlining the limitations and restrictions of your physical abilities. It is also helpful for you to submit a personal declaration of your limitations and restrictions.
- Most group disability insurance policies require that you also file for Social Security Disability Insurance (SSDI) because the long-term disability carrier is entitled to offset any money that you receive.