Skilled ERISA Attorneys Serving Florida State and Surrounding Areas
With around 28% of the state’s adults suffering from a disability of some kind, Florida’s disability rate is slightly higher than the national average. As is the case in every other state, disability insurance policyholders in Florida often have to contend with significant resistance from their carriers at claim time. This issue is even more pronounced in ERISA cases, as the federal legislation often makes life more difficult for insured parties and easier for the companies providing their policies. If you’ve missed out on insurance benefits under an employer-sponsored group disability insurance policy and you think the denial was unfair, contacting a Florida ERISA lawyer is the first step you should take to protect your interests.
Are You Entitled to Short- or Long-Term Disability Insurance Benefits?
Your entitlement to income replacement benefits under an ERISA policy depends on your ability to continue performing as required in the workplace, rather than some general standard of disability. If you’re no longer able to do the tasks associated with any occupation for which you are trained, educated, or suited, you’ll meet the definition of disability set out in most employer-sponsored group disability polices.
Your physician must confirm that you’re disabled (according to the terms of your policy), and administer suitable treatment for your illness or injury. Then, once the elimination or waiting period specified on your policy lapses, you’ll be entitled to file a claim.
Unfortunately, that’s not always the end of the story. Insurance companies devote a large chunk of their resources to fighting claims, even those that are apparently valid. Their lawyers will explore any legal avenue available to them to delay paying you or defeat your claim altogether. As you’ll see, the terms of the ERISA legislation make it easier for insurers to succeed in this effort in many cases.
How ERISA Affects Your Case
The Employee Retirement Income Security Act of 1974 (ERISA) governs most employer-sponsored disability insurance policies in the United States. It sets certain minimum standards insurers must adhere to and aims to provide protections for policyholders. Unfortunately, however, the ERISA appeals process often makes matters more difficult for claimants.
If your insurer rejects your initial ERISA claim, which often happens, they will direct you to complete an administrative appeal. You cannot file a federal lawsuit against the company before completing this appeals process. Your administrative record is the full collection of documentation relating to your claim considered during your administrative appeal. Crucially, you cannot introduce any record or report as evidence in a federal ERISA trial unless it comes from your administrative record.
Insurers often attempt to downplay the significance of the administrative appeal and administrative record during interactions with claimants. They generally will not highlight the fact that the documents you submit during the appeal will be the only documents you can rely on in court later. Without a Florida ERISA lawyer on hand to help you, you might easily make the mistake of omitting important items of evidence, severely limiting your chance of success on appeal.
ERISA imposes other limitations, too. You are not entitled to a jury trial for your appeal, so you don’t have the right to introduce witnesses or cross-examine the defendant’s witnesses.
The Difference Between Individually Purchased & Employer-Sponsored Disability Insurance
ERISA does not apply to your short- or long-term disability insurance policy if you purchased it yourself, without help from the company you work for. In practice, that means you can take your insurance carrier straight to state or federal court in the event of a denied claim with an individually purchased policy. You don’t need to worry about filing a timely administrative appeal or compiling an exhaustive administrative record in Florida.
Outside of the claims and appeals processes, individually purchased long-term disability insurance policies tend to have more favorable general terms than their employer-sponsored counterparts. Their monthly benefits are usually more generous, their elimination periods are often shorter, and some offer an “own occupation” definition of disability.
“Own occupation” means your policy will regard you as disabled once you cannot do, with reasonable continuity, the duties associated with the full- or part-time occupation you had prior to your claim. This is better for claimants than the “any occupation” language that is typical of employer-sponsored policies.
The Role of Your Employer in an ERISA Dispute
As your employer pays for the premiums on your ERISA disability policy, you might imagine they’d be on your side in any dispute with the insurance carrier over rejected or delayed claims. Unfortunately, that’s not always the case.
Remember, insurance premiums increase following successful claims. Employers want to keep their insurance costs as low as possible, so they have no incentive to help you file a comprehensive claim or appeal.
Additionally, your employer may not even be capable of providing the proper type of assistance. Unlike top-class ERISA disability attorneys, HR executives are not insurance experts, and will not be able to give you the direction you require to make sensible decisions in relation to your case. Call an experienced Florida bad faith insurance attorney.
Why Hiring a Florida ERISA Lawyer Might Be a Good Idea
Whether you’re in Florida or another state, a rejected ERISA claim is bad news. Not only have you been diagnosed with a debilitating condition that’s diminishing your quality of life and keeping you out of the workplace, but your financial health is also in a precarious position too.
If you’re concerned about potentially failing to secure your monthly benefits, you need to enlist the help of an experienced Florida ERISA attorney. At DarrasLaw, we’ve dealt with ERISA cases from clients across Florida, winning settlement amounts of all sizes. Whether your claim is big or small, we can help.
Contact us today to schedule a free policy or claim analysis. If you’ve already filed a claim only for your insurer to reject it, we can help you to ensure your administrative appeal is as comprehensive as possible. Submitting your appeal by your insurance provider’s deadline is crucial, so don’t waste time; start the process as soon as you can.