Group Long-Term Disability
Was your long-term disability benefits claim denied by your group LTD provider?
You’re not alone. California insurance lawyers Gianelli & Morris are here to help get you the benefits you deserve.
Individual and group long-term disability (LTD) policies are governed by different sets of rules. Because of the governing law, claims are easier to deny in group policies. That law is, in fact, very favorable for insurers. If you have a disability claim with your group long-term disability insurance provider, you need seasoned legal advice and assistance in order to give you the best chance for coverage.
Savvy policyholders call a qualified attorney to help them with a group long-term disability claim denial, and the smartest call Gianelli & Morris. Our California insurance bad faith law firm has decades of experience working exclusively in the area of insurance law. We’ve fought for countless individuals who’ve been denied the benefits due under their policies, whether individual or group. Give us a call if you are struggling to get the benefits you are due under your group LTD insurance policy.
Appealing a Claim Denial Under ERISA
Most group long-term disability plans are governed by the Employee Retirement Income Security Act of 1974 (ERISA). ERISA applies to most employer plans other than governmental entities and religious organizations. ERISA does not apply to individual plans. ERISA sets out a variety of specific rules for insurers and employees covered by ERISA insurance plans to follow, including with regard to how claims must be filed, how they can be proven, and how denials can be appealed. Unfortunately, courts have a history of rulings in favor of insurance companies when it comes to ERISA claims, so it’s important to follow the rules to a T.
There are very specific rules for appealing from a claim denial under ERISA. First of all, policyholders cannot immediately sue to collect their benefits. Instead, plan members must file an internal appeal within the insurance company that denied the claim. That appeal must be filed within certain time limits. ERISA appeals include all manner of other hidden traps. For example, if your appeal is eventually denied, and you choose to file a lawsuit at that point, you will be limited to the documents in your insurance provider’s file related to the appeal. That means that the documents you bring when you file your appeal may be the only documents you can use for the entire pendency of your claim–if you simply wrote back and responded that you disagree with their decision, you’d be left with no additional documents to support your claims.
For those reasons, it’s important to have a seasoned group long-term disability insurance attorney on your side when filing your initial claims and especially when trying to rebut a claim denial. Make sure that you are building the strongest case for your appeal by having the right legal team on your side.
Common Reasons ERISA Disability Claims Are Denied
It doesn’t take much for an insurance company to deny a disability benefits claim. Claims that might survive under a Social Security disability plan, or a private disability plan, are often rejected under ERISA. Some of the most common reasons long-term disability claims are denied under ERISA include:
- Lack of medical evidence proving a disabling condition
- Missing a deadline or time limit
- Specific exclusions listed in the policy
- Errors or missing information in the claim
- Pre-existing medical conditions
- Symptoms that are not backed up with medical diagnoses
- Information obtained through surveillance, private investigation, and social media undermine the claim for disability
- Employability in an alternate occupation
Remedies for Long-Term Disability Claim Denial
Under ERISA, if you have been wrongfully denied insurance coverage and the insurance company proceeded to reject your appeal, you can file a lawsuit seeking the benefits you are owed. Your exclusive remedies under federal law include recovering the benefits you were wrongfully denied, enforcing your rights under the terms of the plan, and clarifying your right to future benefits under the plan. You might be entitled to attorney fees and interest, as well, should you prevail in your lawsuit. Typically, with the help of a savvy claim denial attorney, you can get your attorney fees repaid when you win a successful benefits lawsuit.
Call Gianelli & Morris for Group Long-Term Disability Insurance Claims Denials in California
For help with a denial of your group LTD claim or other long-term disability insurance issues, call the California insurance lawyers Gianelli & Morris at 213-489-1600 for a no-cost consultation. We’ll take the time to evaluate your situation and let you know how we can help.