Your Questions Answered

What is an ERISA Disability Plan?

Typically disability insurance you receive through your job is governed by the Employee Retirement Income Security Act of 1974 (“ERISA”). Individual policies are usually not subject to ERISA but our firm can assist with non-ERISA claims as well.

We offer free consultations and information about all stages of ERISA disability insurance claims. Please contact us with your questions about policy terms and benefits, assistance filing your claim, appeals or litigation.

What are your rights under ERISA?

For policies governed by ERISA, insurance companies are required to abide by ERISA regulations in the processing of your claim. Unfortunately, oftentimes the insurance companies knowingly violate ERISA regulations and fail to provide a full and fair review of your claim.

Cox, Stansberry & Kinsley has years of experience combatting the deceptive tactics of big disability insurers like Cigna, Unum, Hartford, MetLife, Liberty Mutual, Aetna and others. Let us help you navigate the claims process with you, protecting you from the harassment of the insurance company and fighting for the benefits you deserve.

When do I need a lawyer and how do I pay for one when I′m disabled and not working?

As a general rule, you need to have a lawyer look at your case as early as possible. In ERISA-governed claims, if a lawsuit has to be filed, typically the only information that a judge can review is the information contained in the administrative record created during the appeals process. Missed deadlines can be fatal to your claim so it is helpful to have an attorney ensure all deadlines are properly calculated and met. In most cases, our cases are handled on a contingency fee basis with free initial consultations.

My LTD claim has been denied or benefits have been terminated, what do I do next?

Carefully read your denial or termination letter for appeal deadlines. In most cases, employer-sponsored LTD policies are governed by ERISA, the Employment Retirement Income Security Act of 1974. You will be entitled to one and in some cases, two appeals. In ERISA governed cases, if the insurance company does not overturn its denial during the appeals period you will receive a “final denial” from the insurance company. After you receive a final denial, typically a federal lawsuit has to be filed and usually the only evidence a judge can review is the evidence in the administrative record that was considered by the insurance company prior to the final denial. As such, properly appealing your claim and building a strong, favorable record is critical.

My doctor says I′m disabled, how can the insurance company deny my claim?

Unfortunately, in most cases, the insurance company does not have to give more weight to the opinions of your treating physicians than to its own “hired guns”. The insurance company may send you for an exam by a physical therapist or doctor who it hires and base the denial or termination on the findings of its paid examiner instead of your treating physician. Sometimes insurance companies do not even have their doctors examine you and simply make decisions based on reviews of your medical records alone. Oftentimes, the opinions of these paid examiners and reviewers can be discredited with a good appeal strategy that may include providing the insurance company with detailed opinions from treating physicians and providing the insurance company with your own FCE results.

The Social Security Administration has determined that I′m disabled, how can the insurance company deny my claim?

Insurance companies will often state that the policy at issue has a different definition of disability than the SSA. Insurance companies will also claim that the SSA considers factors the insurance company does not have to consider, such as age. They will also assert that the Social Security Administration is required to give more weight to certain evidence or that the SSA does not have the same evidence as the insurance company. Even if the insurance company is not bound by the decision of the SSA, the SSA file typically contains volumes of favorable evidence that the insurance companies do not request. It is imperative that you make sure the insurance company receives your entire SSA file if it contains evidence favorable to your claim.