Long Term Disability Overview under ERISA

A Federal law known as ERISA (Employee Retirement Income Security Act) is a  comprehensive and complicated law originally enacted to protect employees’ rights to their benefits. Ironically, it is now widely accepted that ERISA protects insurers, not claimants as intended. Here are some reasons why:

ERISA Disputes Take a Long Time

ERISA disability disputes can be very drawn out. Before any federal lawsuit, a denied claimant must, “exhaust administrative remedies” by appealing, in writing to the denying insurance carrier. This is a big deal because denied claimants have 180 days to appeal and insurers have up to 90 days to consider the appeal. By the time the internal appeal has concluded, 270 days have elapsed. During that time, the disabled person is without income from his or her job.

SSDI

Should the disabled person seek social security the long term disability insurer usually is able to deduct SSD from the amount it owes the claimant. Should the disabled person not seek SSD, the long term disability carrier may argue that the disabled person breached a LTD policy requirement that Social Security be applied for.

Evidence for the Claim

Since appeals will be based on medical evidence in the claim file, it is crucial that the claim file be stacked with evidence supporting the claim early on. As bizarre as it sounds, ERISA allows insurers discretion to administer their own policies. If such discretion is given under the plan then a denial can be overturned by a showing that the insurer abused that discretion—a very tough standard.

Lawsuit in Federal Court

Should the denial be affirmed after the internal appeal, then a suit in US District Court is the final option. But suit under ERISA does not amount to “one’s day in court” because testimony is usually not allowed and cases are decided by judges, not a jury or one’s peers. Instead, cases are decided based on briefings of attorneys who argue based on the evidence in the claim file—that is why setting up the claim file in the first place is so crucial.

Drawn Out, Unfair Process

The reality is that few disabled persons have the stamina or resources to put up a fight against a strong, well educated insurance company. Insurers know this. Richard Rizk takes viable long term disability cases on a contingency basis. If you have been denied LTD benefits, complete the online form today on this website to see if you qualify.

Supreme Court Justice Bader in 2009 as well as many respective commentators have expressed that ERISA is unfair and needs revamping. Richard Rizk’s primary goal is to win or settle your disability appeal in the shortest amount of time. His secondary goal: repeal or amend ERISA so disabled claimants don’t twist in the wind while insurers delay. After all, the best result for a disability insurer would be your death after a denial for which no benefits were paid.  Richard Rizk is disgusted with disability insurer tactics and will passionately fight for you.  To complete an online intake form go to rizklaw.com. To change ERISA, email your ERISA story to Richard Rizk at rich@rizklaw.com.