Skilled ERISA Lawyers Serving The State Of Massachusetts
What would you do if an unexpected sickness or accident prevented you from holding down full- or part-time work for an extended period of time? If your current employer provides you with a group short- or long-term disability insurance policy as a perk of your occupation, you might think you’ll simply be able to rely on that. Unfortunately, for many Massachusetts residents suffering from disabilities, the reality is quite different. A body of federal legislation called ERISA often complicates these kinds of claims. That’s why claimants often end up needing the assistance of an experienced and successful Massachusetts ERISA lawyer. At DarrasLaw, we have over 100 years of combined experience in protecting disability insurance claimants from the dirty tricks of insurance companies.
How Does ERISA Affect My Insurance Policy?
ERISA is an acronym for the Employee Retirement Income Security Act of 1974. It’s a highly complex body of federal legislation that sets out minimum requirements and standards for the majority of employer-sponsored short- and long-term disability insurance policies in the United States.
As you’ll see, ERISA favors insurance companies rather than claimants, particularly when it comes to the mandatory appeals process following an unsuccessful initial claim.
Why You Might Need A Massachusetts ERISA Attorney
Insurance companies are not charities. While they’ll claim to be on your side before they sell you, or your employer, a new disability policy, they’ll do whatever they can to avoid paying out on claims. These enormous multinational companies have teams of expert lawyers and an army of claim personnel working for them; unless you have top-rated legal help on your side as well, you’ll struggle to counteract their strategies.
As noted above, ERISA law creates opportunities for disability insurance carriers in this regard. If you file a claim on an individually purchased long-term disability insurance policy and your carrier rejects it, you can simply sue them in a state or federal court. With ERISA group policies, however, you must do a timely mandatory administrative appeal.
The first step here is the filing of an administrative appeal, which includes all the evidence and information through the denial and all the new medical, occupational, financial, and vocational evidence you and the carrier put in the administrative appeal. Your administrative record should contain all the medical evidence that is relevant to your claim. Your insurance company contributes to the administrative record as well, but it will only add the data that supports the case its lawyers are trying to make. You’re responsible for including the records and reports that support your case.
Claimants generally have 180 days to complete the mandatory administrative appeals process. If the administrative appeal fails, you can take your insurer to federal court. Crucially, however, you cannot introduce any evidence in court that is not present in your administrative record or during your initial claim. So, it’s critical that you put together as comprehensive an administrative record as you can, and do so in a timely fashion.
You should also note that you do not have the right to a jury trial under ERISA. You cannot cross-examine opposition witnesses, or introduce witnesses of your own because there is no trial. It’s up to the judge to consider all the information in the administrative record and initial claim and reach a verdict on the basis of all the information in the underlying record.
All of these issues make the help of a seasoned ERISA lawyer crucial following an initial claim denial. Without expert help from a firm like ours, you’re running a much bigger risk of leaving the group disability insurance benefits you’re entitled to on the table.
Conditions That Give Rise To Successful Massachusetts ERISA Claims
Disabling conditions exist on a broader spectrum than many people realize. You can be disabled without showing any obvious physical signs of your illness or injury.
At DarrasLaw, we’ve successfully worked with claimants suffering from a broad range of disabling conditions, including:
- Early-onset dementia: This is an umbrella term referring to a range of conditions affecting cognitive function, the most common and best-known of which is Alzheimer’s disease. Other forms of early-onset dementia include Lewy body dementia, vascular dementia, and frontotemporal dementia. These conditions are much more common in older people but can affect individuals of working age as well.
- Heart Disease: Heart disease describes a variety of illnesses affecting the heart, including cardiac aneurysm, congenital heart disease, postural orthostatic tachycardia syndrome (POTS), and ischemic heart disease (otherwise known as coronary artery disease). Collectively, these types of conditions are the leading cause of death in the United States for both men and women. In non-fatal cases, heart disease can lead to prolonged periods of disability and absence from full- or part-time work.
- Cancer: Strikingly, approximately 38% of Americans will end up with cancer at some point in their lives. The majority of those diagnosed survive, but the road to recovery can be long and arduous, and it often involves extended periods of disability.
Different ERISA disability policies have different approaches when it comes to the coverage of specific illnesses and injuries. Generally, however, you will be entitled to monthly benefits in a situation where:
- Your physician has confirmed and documented carefully and with objective evidence that you meet the definition of disability under the terms of your policy. Most ERISA policies use an “any occupation” disability definition, regarding you as disabled once you cannot carry out full- or part-time work in any occupation for which you are trained, educated, or suited.
- Your physician has treated your illness or injury in the most appropriate medical way.
- The elimination or waiting period specified on your ERISA disability policy has elapsed.
In all cases, you should research your policy documentation carefully to understand exactly what kind of disability insurance coverage you have or ask a Massachusetts Insurance bad faith attorney for free help.
Are Partial Disability Benefits Possible Under ERISA?
One of the most important distinctions between Social Security Disability Insurance (SSDI) and individually purchased or employer-sponsored long-term disability insurance is the availability of partial income replacement benefits. If you develop a condition that limits your ability to work to, say, half your original weekly hours, you can continue to work that much and apply for disability insurance benefits to make up the difference.
By contrast, the Social Security Administration does not grant partial income replacement benefits for disability. You must have a total disability (one that prevents you from doing any work at all for which you are trained, educated, or suited) in order to receive SSDI benefits.
Protecting Your Interests by Hiring An ERISA Disability Attorney
As you can see, some legitimate and genuine claims don’t always result in the granting of income replacement benefits by insurance companies. To give yourself the best chance of securing what you’re entitled to in terms of group disability monthly benefits in a case like this, you should enlist the help of a Massachusetts ERISA lawyer.
Contact DarrasLaw today to put your case in the hands of the most competent disability insurance lawyers around. Our initial policy and claim analysis are always free. Filing a comprehensive and timely administrative appeal is crucial, so don’t waste any time in starting the process if you’ve already received an initial claim denial.