Skilled ERISA Attorneys Representing Clients in New York City, NY
New York City is arguably the world’s most famous urban hub. A hive of activity, the Big Apple is known for its countless attractions, including the Statue of Liberty, the Empire State Building, and the Brooklyn Bridge, as well as its unique culture and atmosphere.
Of course, this enviable setting comes at a price. According to recent statistics, New York is the second most expensive American city to live in. If you found yourself unable to work because of a sickness or injury, life in the city would likely become unaffordable very quickly.
Our expert New York City ERISA Lawyer offers assistance to people in this position who are struggling with claims on their employer-sponsored group disability insurance policies. The federal law in this area can often make life very difficult for New Yorkers living with disabling conditions.
The Employee Retirement Income Security Act of 1974 (ERISA)
ERISA is a highly complex and ever-changing body of legislation. It governs the majority of employer-sponsored group disability insurance policies, setting minimum standards to which insurance carriers must adhere.
The legislation also prescribes strict mandatory processes by which you must file initial claims and appeal submissions in relation to employer-sponsored disability insurance. As you’ll see, these processes favor group insurance carriers more than insured parties. This is part of the reason why a New York City ERISA Lawyer can provide such a valuable service to their disabled clients.
What Do New York City ERISA Attorneys Do?
Our job is highly complex, owing to the difficult nature of disability insurance claims and the complicated ERISA rules in relation to claims and appeals. We offer help to clients at every stage of the process, including the initial claim, the mandatory appeals process, and in federal court litigating the ERISA case.
Holders of individually purchased long-term disability insurance policies can sue their providers right away if they receive a wrongful claim denial. ERISA policyholders, however, must complete a comprehensive, timely, mandatory appeals process before they can bring their insurer before a federal judge. This process involves the compilation of a comprehensive administrative record including all the medical, financial, occupational, and vocational data and reports that support your case. Failure to include a vital piece of evidence could destroy your claim, which is why expert legal disability help is so valuable at this stage of the process.
Another complication in terms of group ERISA disability lawsuits is the fact you do not have the right to a jury trial when litigating an unfavorable result. You cannot call your own witnesses to the stand, you cannot cross-examine opposition witnesses, and you cannot use the discovery process to gather evidence from your insurance company. Only the evidence submitted during the claim and the appeal will be considered by your federal ERISA judge.
Yet another issue is time. ERISA imposes very strict deadlines on claimants when it comes to claims and appeals. Miss one, and it could defeat your entire claim, even if everything else about the claim is valid.
As ERISA is a federal law, it applies to insurance policies in all 50 states. However, legal precedent from past cases differs from one court jurisdiction to the next. Our lawyers have extensive experience with the procedures and precedents that apply in the Second Circuit, in which New York City is situated.
Your Group Administrative Record
The compilation of the administrative record is perhaps the most crucial part of the mandatory appeals process during an ERISA disability claim.
Following an initial claim denial, your insurer will give you approximately 180 days to submit an administrative appeal, as per ERISA rules. Alongside your insurer, you must put together a full account of all the medical evidence, records, and reports that are relevant to your claim. You and your New York State ERISA lawyer are responsible for including all the pieces of evidence that support your case at the administrative level.
If your initial appeal fails, you can sue your ERISA insurance provider in federal court. However, you can only include evidence that appears in your administrative record and the claim through denial. Any further evidence at this point is inadmissible, making the timely submission of a comprehensive administrative appeal crucial for success in ERISA group disability cases.
What Are Group ERISA Disability Benefit Offsets?
Insurance carriers generally do everything in their power to limit the amount of money they need to pay claimants. One tool they have in their arsenal in this regard is benefit offsets. These are obligations insurance companies write into their policy contracts requiring you to forgo a portion of your monthly benefits if you’re receiving an income from another source.
Say, for example, you qualify for both ERISA disability benefits and Social Security Disability Insurance (SSDI) benefits. Your insurer may be contractually entitled to subtract the amount of your monthly SSDI benefits from the amount it pays you for your group disability claim along with any dependent children offsets.
Remember, the Social Security Administration requires you to be totally disabled before you start receiving disability benefits. Unlike ERISA disability policies, SSDI does not provide benefits to individuals with partial or short-term disabilities.
Even if you clearly don’t meet the standard for SSDI, you may still have to file an application and wait for your rejection letter before the issue of offsets is resolved.
Stay Financially Sound Using A New York City ERISA Lawyer
As you can now see, employer-sponsored group disability insurance coverage is highly complicated. Having a group disability policy doesn’t guarantee that you’ll immediately start receiving monthly benefits after filing a valid claim, as insurers will do whatever they can to delay payments or avoid approving your claim altogether.
To give yourself a fighting chance, you should hire a seasoned and dedicated New York City ERISA lawyer. Contact DarrasLaw today to schedule a free initial policy analysis or claim assistance.
If your insurer has already denied your initial claim, we can help you submit a comprehensive administrative appeal in a timely fashion. Alternatively, if you have yet to file an initial claim and are not sure how to start, we can help at that stage too.