Skilled ERISA Lawyers In Boston, Massachusetts
Boston, Massachusetts is one of the most densely populated cities per square mile in the United States. It has a rich history and unique cultural traditions. Unfortunately, disability affects working Bostonians in much the same way as Americans from anywhere else in the country.
Many Boston residents work in full- or part-time jobs that provide short- or long-term disability insurance (also known as ERISA disability insurance) as a perk of employment. Unfortunately, this benefit doesn’t always guarantee you’ll remain financially sound in the event of disabling sickness or injury. ERISA insurers often try to avoid or delay paying out on legitimate claims.
An expert Boston ERISA lawyer at DarrasLaw can help you if something like this happens to you following a claim denial.
What Is ERISA?
The Employee Retirement Income Security Act of 1974 (ERISA) is a complicated body of federal legislation that governs most short- and long-term disability insurance policies that employers provide for their workers in the United States. While it sets minimum standards and other protections for the benefit of employees, its rules in relation to insurance claims and appeals present many challenges for ERISA claimants.
Chief among these challenges is the mandatory and time-specific ERISA disability appeals process. Following an initial claim rejection, your group disability insurance carrier will give you a period of time (typically 180 days) within which to file a mandatory administrative appeal. As part of this process, you’ll have to include all the medical, financial, occupational, vocational, and other reports supporting your claim, as well as case law specific to where you live, in an administrative record.
This administrative record is vitally important. Once you submit it, you generally cannot introduce any evidence in a subsequent federal lawsuit that doesn’t appear in the administrative record or your initial claim filing. Insurers often try to take advantage of this rule by downplaying the importance of a full and comprehensive administrative record when claimants are submitting appeals. This leads many people to omit crucial pieces of evidence, potentially jeopardizing their valid claims thinking their lawyers can do it later.
Another major issue with the ERISA rules is the fact they don’t provide you with the right to a jury trial when you file your lawsuit in federal court. You cannot introduce your own witnesses in court, nor can you cross-examine those of your insurance company because your federal judge only reviews the claim and appeal, and rules on the papers.
Having a seasoned Boston ERISA lawyer on your side during the appeals process is the best way to ensure one of these pitfalls doesn’t ruin your claim.
Individual vs. Group Long-Term Disability Insurance
If you file a claim on a long-term disability insurance policy you purchased yourself, you can immediately sue your insurance carrier in state or federal court if they try to avoid paying out. There’s generally no need to engage in a mandatory appeals process like the one described above.
An additional advantage of individually purchased long-term disability insurance is the fact it covers you personally, not just your occupation. If you work a weekend job as well as a Monday-Friday, 9-5 position, your individual policy should replace the income streams from both occupations if you develop a disabling condition. However, if your employer provides you with insurance as a benefit, it won’t cover any income you earn outside that job, and it generally won’t follow you if you leave that company to take up another position.
Another key difference is the definition of disability on the group and individual policies. Some employer-sponsored plans use an “any occupation” disability definition. This means your insurer will not accept your condition as a disability unless it’s preventing you from carrying out the essential duties of any occupation for which you are trained, educated, or suited. Some individual policies offer a version of the more generous “own occupation” definition. Under these individual policies, you’ll be disabled (for insurance purposes) once you become unable to carry out the necessary duties associated with the occupation you had immediately prior to your accident or sickness.
When & How You’ll Receive Boston ERISA Benefits
In order to collect on a Boston group ERISA disability claim, you must first:
- Visit your physician and have them confirm the nature and extent of your illness or injury, as well as the functional limitations it’s imposing on your ability to work. Your physician must agree that, because of your condition, you’re unable to effectively work in any occupation for which you are trained, educated, or suited.
- Receive appropriate treatment from your physician for your illness or injury.
- Allow the waiting or elimination period on your policy to elapse. These periods are generally much longer on ERISA policies than individually-purchased long-term disability plans.
Lump-sum payments are possible in ERISA disability cases. If you have considerable expenses that you need to cover in the immediate term, this might be a good option for you. However, your individual circumstances, such as the length of time you’ll be entitled to monthly benefits payments and your needs in terms of ongoing medical care, should always come into consideration in this decision.
Another factor to consider is the possibility of benefit offsets. Your ERISA group disability policy may say the company can offset any money you earn from other sources. To this end, your policy may require you to apply for Social Security Disability Insurance (SSDI) benefits which will offset dollar for dollar from your long-term disability monthly benefit.
How A Boston ERISA Disability Attorney Can Help
As you can see, the claim and appeals processes in cases surrounding employer-sponsored group disability insurance policies are far from straightforward. The stakes are too high to leave anything to chance. If you want to give yourself the best possibility of collecting your claim, you should hire a seasoned and successful Boston ERISA lawyer.
To schedule a free initial policy or claim analysis, contact DarrasLaw today. Remember, filing a timely and comprehensive appeal is crucial if you’ve already met with an initial group ERISA claim denial.