ERISA Attorney

Many employers offer benefits to their employees. Unfortunately, however, employees routinely have their life insurance and long-term disability claims delayed or denied under employer-sponsored insurance plans—often without good reason. If you are dealing with a delayed or denied life insurance or long-term disability insurance claim on a policy offered through your employer or an employee group, you may have grounds to challenge the denial. However, to increase your odds of a successful outcome, you should enlist the services of an experienced ERISA attorney. When you come to us for assistance, we will do everything possible to obtain a successful result on your behalf. So, if you are facing an insurance claim denial, please contact Life Legal today.

The Employee Retirement Income Security Act of 1974, commonly known as ERISA, is a federal law that governs all private employer-provided employee benefit plans. Some types of plans, such as government-sponsored and church-sponsored plans, are exempt from ERISA. (Other laws, including the Internal Revenue Code, do apply to these types of plans.) ERISA applies to employee welfare benefit plans and employee pension plans offered by private employers.

Although ERISA applies to plans offered by private employers, it does not require employers to establish benefit plans. However, once an employer does establish such a plan, it must follow ERISA’s minimum eligibility, disclosure, vesting, and funding requirements. ERISA also codifies fiduciary rules that apply to trustees and other individuals that administer and manage these plans. When violated, a fiduciary can be held personally liable for any harm resulting from violations of ERISA’s fiduciary rules.

In addition, ERISA provides several protections for employees, including mandatory disclosures and claims procedures that plans must follow. ERISA also provides beneficiaries and participants with the right to file a civil suit in federal court and collect certain fees and costs related to the litigation if the suit is successful.

Claims for benefits under ERISA are routinely denied—often without good cause. As noted above, at Life Legal, we help our clients obtain benefits following life insurance and long-term disability claim denials under employer-sponsored insurance plans. There are many reasons that such claims are denied, such as:

• Death during the contestability period
• Cause of death not covered by the life insurance plan
• Failure to disclose information
• Fraud
• Failure to pay premiums
• Failure to convert/continue coverage following termination of employment

As noted above, ERISA disability claims are also routinely rejected, leaving employees and their families on the hook for related expenses. Common reasons for the denial of ERISA disability claims include:

• Paperwork mistakes
• Missed deadlines
• Lack of medical evidence for a disability
• Pre-existing conditions
• Undocumented symptoms and inappropriate treatment
• Policy exclusions or limitations on benefits or coverage

Although insurance companies often offer multiple reasons for claim denials, one thing is for sure: Regardless of the reason for your claim denial, you need an experienced legal professional to assess your situation and pursue your available options. If your claim under an employer-sponsored insurance plan has been denied, contact the experienced life insurance lawyers at Life Legal today for a free consultation.

Following an insurance claim denial, you have specific rights as defined by the ERISA claims procedures regulations. Your rights under ERISA include the right to receive specific information regarding the denial and the right to appeal the same. Specifically, following a denial, your plan administrator must provide you with a notice containing the following information:

• The reason(s) for the denial
• The specific plan provisions on which the denial was based
• A description of any additional information or material needed for the insurance company to reconsider the original claim
• A description of the plan’s review procedures, including all deadlines and timeframes
• The internal guideline, rule, or protocol that was relied on by the plan administrator to make the adverse benefit determination
• If the denial was based on medical necessity, an explanation of the clinical or scientific judgment used to determine that the claim should be denied
• A description of the review process applicable to your claim

If you have had your ERISA life insurance or long-term disability insurance claim denied or delayed, contact an insurance claim attorney for assistance as soon as possible. No matter where you are located in the U.S., Life Legal can help you navigate the ERISA litigation process. At Life Legal, we will fight hard to help you obtain the benefits that are rightfully yours. We are dedicated to helping people who have been unjustly denied ERISA life insurance and long-term disability benefits. When you come to Life Legal for assistance with your denied claim, we will help you navigate the legal process and fight hard to protect your legal rights. With Life Legal in your corner, you can rest assured that you will always be kept apprised of the status of your case, be kept informed about any important developments, and have direct contact with the ERISA attorney handling your claim denial appeal. So, if you are ready to take the first step in obtaining the benefits that are rightfully yours, please contact us today to schedule a free consultation with one of our talented attorneys.