Pennsylvania Attorney: Disability Insurance Claims
ERISA disability claims arise in the context of employer provided benefits (disability insurance provided through an employer’s benefit plan). When you are injured and apply for disability benefits, a plan administrator will make a decision granting or denying your request for benefits. The plan administrator makes its decision based on a review of written documents (e.g., medical records). Typically, the plan administrator will not conduct an oral interview, and employees do not have a right to a full hearing at the initial stage of consideration. The plan administrator is often affiliated with the source that will pay the benefits that are awarded to you.
ERISA - Get an Experienced Disability Lawyer as Early as Possible
If an employee's request for disability insurance benefits is denied, there is an appeals process to an appeal adjudicator or committee within the insurance company. The notification of the initial decision and your appeal rights are sent to you in a letter. This makes the process appear to be very informal. Many qualified applicants are fooled into believing that they can handle the appeal without the help of a lawyer.
Once all the available appeals to the company have been made, you have the right to make an appeal to the federal district court in your area. This is often the first time that applicants seek the help of an attorney, because formal court proceedings are involved. It may be too late, at that stage, for an attorney to help you.
At the federal court level, employees have extremely limited or no rights to add evidence to the record, and the district court is required to give a great amount of deference to the plan administrator. The standard of review is called an "arbitrary and capricious" standard. In layman's terms, this means that the district court will uphold the plan administrator's denial of benefits unless the decision-making process was woefully unfair. It does not matter whether the federal judge might have concluded the applicant was disabled using the same evidence. As long as the denial has some support in the record and the administrator gave the applicant a fair opportunity to present her case, the denial will likely be affirmed.
Therefore, it is critical to make a strong case for benefits as early as possible. Using the same techniques it uses to help social security and workers' compensation clients, McGraw & Associates, LLC helps you build the most comprehensive file possible to insure that the case is won before you need to go to federal court. We will help you create a file that includes evidence that long-term disability plans do not normally ask you for, but that is designed to persuade the decision makers that your disability is significant and legitimate. If the case has to go to federal court, you will then have the strongest possible record to argue that the decision was "arbitrary and capricious."
What to Do if You Make a Claim for Disability Benefits
If you have disability insurance and have sustained a serious injury, there are three things to remember:
1) Get a lawyer as soon as possible.
2) Get all of your evidence in at the administrative level before your claim has to go to federal court. Work with an attorney that is familiar with proving disability to make that evidence as persuasive as possible.
3) Make sure you exhaust all levels of administrative appeals before the plan in a timely manner. If you do not exhaust all your appeals before the plan, the federal courts cannot hear your appeal.
Protect Your Rights
If you have been injured, retain an attorney who can advise you of your rights and handle your case properly. Let your plan administrator know that you mean business. Retaining an attorney will send a clear message that you are taking your case seriously and treating it with the formal attention it deserves.
If you reside in Pennsylvania, we encourage you to contact our law office in Skippack, Pennsylvania. The founder of our firm, attorney Terence Sean McGraw, has been helping injured and disabled workers for more than 20 years. In addition to ERISA disability insurance claims, he has extensive experience in workers' compensation and Social Security Disability claims.
Schedule a Free Consultation
We charge no fee to discuss your case. In addition, we usually charge no fees unless we recover for you. To speak with an attorney about workers' compensation, unemployment benefits or the Employee Retirement Income Security Act, contact our Skippack law office at 610-584-9400 (Ext. 116). You may also contact us by e-mail.
