ERISA Long Term Disability Benefits and Insurance Disputes

ERISA: The Employee Retirement Income Security Act of 1974, commonly known as ERISA, is a federal law that often controls long term disability claims when the long term disability coverage is provided through one's employer rather than a private long term disability insurance policy. When ERISA governs a disabled person's claim, the disabled claimant is at a disadvantage while the insurance company benefits.

When a person becomes disabled from working due to an injury or illness, strain on the disabled victim is tremendous. Unfortunately, disabled individuals with long term disability insurance are often shocked at their insurer's outright refusal to pay benefits. That's when you need an ERISA attorney to represent you. Disability insurance policies are written to favor the insurer. The applicable law is, likewise, unfavorable to the insured. However, an experienced disability attorney can successfully reverse an unfair denial of disability benefits.

Long term disability insurance companies are corporations whose goal is profit. After they receive insurance premiums from their insureds, they maximize their profits by minimizing what they pay in claims. The disability insurance company collects premiums from you as long as possible, then will often deny your claim no matter how legitimate it may be once you become disabled and need benefits. They may even initially approve you for short term disability (STD) or long term disability (LTD) only to buy time while gathering information in an effort to later deny your claim.

In many cases, policyholders do not challenge an unfair denial of disability benefits, believing it would be too costly, and that they would probably lose. But many who exercise their rights to appeal and litigate win their benefits. In order to be entitled to ERISA disability benefits, you must meet the policy's definition of "disability," which varies from policy to policy. You will need to consult an ERISA attorney to find out if you have a case. Even if you are found to be totally and permanently disabled in a Social Security disability claim, this does not automatically mean that you meet the disability insurance company's definition of "disability."

Disability insurance companies often deny claims based on technicalities. The insurance companies will use their own paid medical consultants to provide input despite never having treated or even examined you. These insurance company medical consultants will often even disagree with your own treating physician who sees you on a regular basis. Then the insurance company will often accept its own medical consultant's opinion regarding disability and disregard the opinion of your treating physician completely.

The insurance company will also ask you to sign forms authorizing collection of personal information. They will even hire private investigators to investigate, follow, and take video of you to destroy your disability claim. The disability insurers will often use your signed authorization forms to collect medical and other personal records dating back years prior to your disability to support any conceivable argument to deny your claim, invading your personal privacy and exposing background information that is absolutely unrelated to your disability. Hire an ERISA attorney as soon as possible.

Even if you know that you cannot continue working, the disability insurance company will consider your opinion worthless. The insurance company's decision to deny your claim depends on a claims examiner who has no formal medical training whatsoever.

Many people do not even think of hiring an attorney until they are denied long term disability benefits. If you are denied long term disability benefits, the best time to hire an ERISA attorney is immediately, before an administrative appeal ofthe claim. An ERISA lawyer can gather and provide the evidence required to maximize the chances of winning the administrative appeal.

If you ultimately decide to hire us for your long term disability insurance claim, we handle it on a contingent fee basis. We receive compensation only if you win.


At the Louisiana office of Scott D. Wilson, A Professional Law Corporation, we represent clients throughout Baton Rouge and the surrounding areas, including those in New Orleans, Lafayette, Lake Charles, Alexandria, Shreveport, and Monroe, Denham Springs, Prairieville, Gonzales, Zachary, Brusly, Port Allen, Livingston, Walker, Watson, Livingston Parish, Ascension Parish, East Baton Rouge Parish and West Baton Rouge.