Atlanta, Georgia, ERISA Attorneys
For most American workers, the benefits that come with one’s job are a substantial portion of the employer’s total compensation package. One of the most important benefits in that package can be long term disability insurance. Life is full of surprises, not all of them good. When you are covered by term disability insurance through your work, you may feel confident that you still have economic security even if you are unable to work. Sadly, all too often that confidence turns out to be misplaced. The Georgia ERISA disability denial lawyers at Evans, Scholz, Williams & Warncke, LLC can restore your confidence by fighting for the insurance benefits you deserve.
What is ERISA?
The federal government passed a law in 1974 that regulates employee benefits, the Employee Retirement Income Security Act (ERISA). ERISA covers the benefits of workers employed by private companies. Congress intended that ERISA was supposed to provide “enhanced protection” of employee benefits. Unfortunately, the law backfired completely, and it has never been fixed. ERISA now frequently works in the favor of the insurance companies, and consumers would probably be better off if the law was completely dismantled.
How Are ERISA Disputes Different from Denials of Individual Disability Claims?
There are two major drawbacks to ERISA claims compered to an individually purchased disability policy. If a dispute arises relating an ERISA long term disability benefit:
- You are not allowed to file a typical lawsuit in which you call witnesses and provide additional evidence or testimony. Before you ever file suit you must submit an “Administrative Appeal” asking the insurance company to review its own decision. If you don’t file a timely appeal your claim is dead – forever. The appeal may be reviewed by a federal judge, but he only sees the insurance company’s claim file – a cold stack of paper. The judge never lays eyes on you or any other witness.
- Under ERISA even if the insurance companies found to have acted abusively or fraudulently you may not bring a bad faith claim or seek extra money damages. The court can order the insurance company to pay the benefits plus your attorneys’ fees, but that is not much of a deterrent in our experience. ERISA invites insurance company abuse.
Before you file for long term disability benefits, it is a good idea to speak with an ERISA disability denial attorney who works specifically with these cases as a regular practice area. ERISA law is a specialized area of practice, and one very few attorneys have the experience to handle. We have seen some very bad outcomes in cases where the policyholder was represented by a well meaning, but inexperienced, attorney.
Disability and the Law
Under ERISA, long term disability policy’s the definition of “disability” can be very different from what most laypeople expect. Most ERISA policies pay benefits for only twenty-four months for being unable to perform one’s “own occupation.” Moreover, tricky definitions of “own occupation” may mean the insurance company more or less ignores how demanding your job actually was in evaluating your disability.
After twenty four months most ERISA policies stop paying benefits unless you are disabled from performing “any occupation.” This is generally considered a much tougher burden, and many disabled people find their benefits terminated when the policy goes from “own occupation” to “any occupation.”
Most ERISA LTD policies also limit benefits to 24 months for “mental and nervous disorders,” even if the worker is completely unable to work in any job. We have seen these policy limitations applied not only to conditions like depression, anxiety and bipolar disorder, but also to traumatic brain injury. We have successfully fought the application of this “mental and nervous limitation” many times, sometimes leading to the payment of many more years of disability benefits.
Choosing the Right Long Term Disability Lawyer
The wording of a disability policy is often dense, complicated, and ambiguous. Even though your insurer wrote the policy and could have made it as clear as they wanted, the insurer may try to take advantage of unclear or ambiguous wording. While in some legal jurisdictions that is considered illegal conduct, insurance companies do it anyway, and they frequently get away with it.
It is important to have an ERISA disability denial lawyer working for you who understands the complexities of insurance policy language, both when filing the claim and when opposing a claim denial. Your lawyer should be thoroughly experienced and familiar with the tactics these companies employ to avoid paying a claim. The ERISA lawyers at Evans, Scholz, Williams & Warncke not only know ERISA law, they have helped create ERISA law that helps consumers and holds insurance companies accountable. Very few Georgia attorneys consistently handle ERISA claims, so it is important that you do your homework in order to ensure that you have the best attorney for your case. Your future may depend on it.
Atlanta Disability Attorneys
When you come to the Atlanta law offices of Evans, Scholz, Williams & Warncke, LLC for help with your long term disability claim, you can be assured that your Georgia ERISA disability denial lawyer understands the ins and outs of both ERISA and state laws, and the sometimes nefarious methods the insurance companies employ. Our attorneys know how to make the crucial link between the medical condition causing the impairment and the inability to perform the job. We will also educate your doctors on the necessity of articulating specific details that make this connection clear.
In the language of ERISA claims, your impairment needs to be defined in terms of
- Restrictions, which are activities you cannot do at all, and
- Limitations, which are activities that you may be able to perform to some degree, but with considerably less intensity or frequency, or you require a significantly greater amount of time to complete a job function than the activity would normally require.
We will analyze your medical reports and application forms and examine your insurance policy in the most minute detail . We will gather additional documentation to support your claim, including helpful statements from your family, employer, coworkers, therapist, doctors and other healthcare providers, and often, a vocational specialist. In many cases, we will request from your doctor an additional and very detailed statement addressing your particular restrictions and limitations and the manner in which they affect your job performance.
Our highly skilled ERISA disability denial attorneys will represent you in your Administrative Appeal, which is your final shot at having your claim approved. This is the most important part of the ERISA process, as it is your last opportunity to submit evidence in support of your claim, so it must be prepared with meticulous care to every detail. Our lawyers have an excellent record of having our clients’ cases approved at this level. If the insurance company still refuses to pay, the “administrative record” goes to a federal judge for review. The preparation that we do in your behalf pays off in a very large percentage of the cases we accept.
Call Today for a Free Case Review
Our Georgia insurance firm has an impressive 95 percent success rate in gaining approvals on individual and ERISA disability claims, and we have recovered in excess of 15 million dollars in claims for our clients after an initial denial by their insurer. Call us today for a free case evaluation and to learn how we can help.