If you have been denied your employer-sponsored long-term disability benefits, it’s time to hire an expert ERISA appeal lawyer who understands the complicated how ERISA works.

ERISA, or the Employee Retirement Income Security Act of 1974, is a complex area of federal law that was designed to govern employee benefits plans like retirement, health, and disability benefits.

Due to its complicated nature, ERISA frequently benefits the insurance company, rather than the insured. That’s why it’s important to hire an ERISA long-term disability lawyer early on so that you have a solid strategy and strong appeal to win.

Know your rights in the ERISA appeal process

ERISA guarantees you an administrative appeals process when you are first denied. However, if your claim remains unresolved, your options will become far more restricted. For example, if you have exhausted the administrative appeals process, your only opportunity to pursue your long-term disability benefits is to file a lawsuit in federal court.

Federal courts have sole jurisdiction over ERISA long-term disability claims/lawsuits. Moreover, your lawsuit must be reviewed by a federal judge. You will not have the opportunity to present a well-reasoned case to a receptive and impartial jury.

Filing your ERISA lawsuit

Once you file your ERISA lawsuit, the merits of your claim are out of your hands.  A federal judge must now use either a “de-novo” or “arbitrary and capricious” standard to review your claim. The standard that the judge will use to evaluate your case depends on the details of your long-term disability policy.

  • De-novo is the best-case scenario and allows the judge to review the merits of your claim independently. You do not get to influence the judge with new evidence. However, you do get to rely on his or her judgment. Assuming there is merit to your claim, it very well might be enough to get your long-term disability denial overturned.
  • Arbitrary and capricious is also known as the “abuse of discretion” standard. This does not allow the judge to make an independent determination on the merits of the claim. Instead, the judge must assess if the insurance company evaluated and subsequently denied your benefits in an incorrect, irrational, or unreasonable manner. Unfortunately, this is both the hardest and the most common type of review standard applied in long-term disability lawsuits.

No new evidence allowed

It is critical to make a deliberate effort to set up your administrative appeal correctly. When you are in a federal court ERISA lawsuit, the facts of the case are already set. At that point, you cannot add new information.

It is critical to make a deliberate effort to set up your administrative appeal correctly.

In some ways, ERISA seems to protect long-term disability insurance companies better than the beneficiaries of the policy. Nowhere is this truer than in the compensation you can expect to receive if it is found that the insurance company was, in fact, wrong to deny you. If this is the case, and you overcome a denial of benefits at the federal court level, the best you can expect to recover is the past due benefits you have yet to receive.

When they’re wrong, you lose

There is no recourse for the wrong decisions made by insurance companies that have caused you financial and emotional distress. If there were a way to hold the insurance companies accountable for poor decision making, they would be more concerned about being correct the first time. Instead, they err on the side of denial and make you prove beyond doubt that you deserve your disability benefits.

ERISA law is exceptionally complex. Don’t go at this process alone.

Read more: What’s the Difference between ERISA and Individual Disability Insurance?

Hire an expert ERISA Appeal lawyer

Roy Law Group knows ERISA law, and our expert team goes up against big insurers every single day. If your long-term disability benefits are denied, hire the best ERISA lawyers to battle big insurance on your behalf.

Contact Roy Law Group today and speak with one of our compassionate team members.