Trusted ERISA Lawyers Serving Clients In Hawaii
The state of Hawaii is famous around the world for its natural beauty and unique culture. People come from all around to vacation in Hawaii; unfortunately, however, this popularity comes at a price. Hawaii ERISA attorney found that Statistics show Hawaii is the most expensive of America’s 50 states to live in.
The sky-high cost of living in the state quickly becomes an issue when you find yourself unable to earn an income because of, say, a disability. The good news is that many employers prepare their staff for this possibility by sponsoring group disability insurance. The bad news is that ERISA, which is the body of federal legislation governing this kind of insurance coverage, frequently presents stubborn challenges for claimants.
The only way to overcome these issues is often to hire an experienced Hawaii ERISA attorney.
Common Disabling Conditions in Hawaii
When you think of disability, you might immediately picture someone who is confined to a wheelchair. However, disability covers a much broader spectrum of health issues.
According to the most recent CDC statistics, there are over 250,000 adults living with some form of disability in Hawaii. The most prevalent categories of disability affecting Hawaiian adults are mobility and cognition, with disabilities related to vision, hearing, independent living, and self-care also common.
You do not have to be totally disabled to qualify for benefits under an ERISA disability policy, as is the case with Social Security benefits. You simply have to meet the definition of disability under your insurance policy; most group ERISA policies define disability as an inability to carry out the necessary duties associated with any occupation for which you are trained, educated, or suited.
How ERISA Works
The Employee Retirement Income Security Act of 1974 (ERISA) sets out a broad range of rules and standards in relation to employer-sponsored insurance and retirement plans. ERISA has a huge impact on disability insurance claimants.
To understand why the legislation is so consequential, we must look at the claims and appeals processes it sets out for policyholders. If you file a claim and your insurance company rejects it, the terms of ERISA require you to file an internal appeal (otherwise known as an administrative appeal) with the company before taking the matter to court.
Different insurance carriers and policies impose different time limits on appeals. On average, you’ll have 180 days to submit your administrative appeal following the initial denial of your claim. This might sound like plenty of time, but preparing for the appeal is a time-consuming process. You need to compile an administrative record with all items of data that are relevant to your claim.
ERISA insurers typically take between 45 and 90 days to respond to appeals. If your carrier decides to reject your appeal, you may then sue them in federal court. However, these lawsuits are restricted in a number of ways by ERISA rules. Most significantly, you cannot introduce any medical records or reports as evidence unless you included them in your administrative record during the appeals process.
This rule frequently causes genuine claims to fail. Insurance companies don’t stress the importance of the administrative record when claimants are going through the appeals process. Many individuals who compile their administrative records without expert legal assistance fail to include vital pieces of evidence, accidentally ruining their chances of ever collecting on their claims.
You do not have the right to a jury trial during the ERISA appeals process, meaning you cannot cross-examine witnesses that appear on behalf of insurance companies or call witnesses of your own. The legislation also provides that you’re not entitled to damages for emotional distress or punitive damages in the event your lawsuit is successful. Help form a Hawaii disability lawyer might be necessary.
What a Hawaii ERISA Attorney Can Do For You
We encourage anyone considering submitting a disability insurance claim to contact our Hawaii ERISA attorney before filing their initial claim, especially when the policy in question is employer-sponsored. That’s because having expert legal assistance from the outset of the process helps to manage the difficulties the ERISA legislation poses.
Firstly, our attorneys can help you to file a comprehensive initial claim or administrative appeal. We know exactly what information must go into your administrative record, including:
- The objective medical issues and subjective determinations in your physician’s chart notes,
- The results of any scans or other medical tests you’ve undergone in relation to your disability,
- Details of how your disability affects you in the workplace,
- Pharmacy records,
- The limitations, caps, restrictions, and other provisions of your ERISA policy that are relevant to your case,
- Any adverse side effects you may suffer from certain medications,
- Specific ERISA violations your insurer may have committed, and interpretations of the legislation from the US Court of Appeals for the Ninth Circuit (this is the court all federal appeals from Hawaii go to).
Hawaii Temporary Disability Insurance vs ERISA Disability Insurance
Most working residents of Hawaii benefit from a state scheme called temporary disability insurance (TDI). Under the terms of the program, employees who become temporarily disabled are entitled to receive a percentage of their working wage from their employers for a period of up to six months. There are minimum eligibility requirements in terms of the length of time worked and the amount of money earned prior to the onset of the disability.
TDI can act as a replacement for an ERISA short-term disability insurance policy. However, because you cannot claim TDI benefits for longer than six months, it cannot replace long-term disability insurance. Long-term policies, whether they’re employer-sponsored or individually purchased, can continue paying monthly benefits until you reach retirement age, depending on the terms of your policy.
Remember, while many Hawaii workers enjoy ERISA policies as a benefit of employment, they’re not guaranteed. Temporary disability insurance, on the other hand, is available to every eligible full- or part-time worker in the state.
If you’re confused about your coverage or entitlements, you should ask your employer about your situation and carefully research any policy documents you have and speak with a Hawaii ERISA attorney.
When to Call a Hawaii ERISA Attorney
Dealing with an ERISA insurer that refuses to act in good faith can be a scary process. Many policyholders lose hope and give up on securing the income replacement benefits to which they’re entitled because of the sheer frustration involved. At DarrasLaw, we understand those challenges, and we’re here to help you overcome them, having dealt with large and small ERISA claims from clients across the state of Hawaii.
Contact us today to schedule a free initial consultation with one of our experienced Hawaii ERISA attorneys. If you decide to work with us following a claim denial, we’ll get moving on your case right away so that you won’t be at risk of missing any important deadlines.