Injury Attorneys Serving Denver, Boulder & Fort Collins, CO
Helping You with Your Long-term Disability Claim
Most American employees are covered by the Employment Retirement Income Security Act (ERISA), a federal law passed in 1974 to ensure that pension, long- and short-term disability, and health benefit plans meet certain standards. If your ERISA claim has been denied or delayed, you have the legal right to appeal the decision and even file a lawsuit if necessary. Because ERISA claims are complex, it’s critical to have a lawyer review your paperwork to ensure that your file is in order. Contact ERISA attorney J. Todd Tenge at the Tenge Law Firm, in Boulder and Fort Collins, to discuss how he can help improve your chances of recovering the benefits you are owed.
ERISA Overview and Terminology
- Group Policy: an insurance policy that covers multiple employees
- Pension Benefits: benefits paid under a pension plan (i.e. to retirees, based partly on years of service)
- Plan Administrator: either the employer or insurance agency; responsible for plan compliance and may amend, modify or terminate the plan
- Plan Document: explanation of the plan’s rules and terms
- Plan Participant: employee enrolled in the plan (aka “the claimant” or “the insured”)
- Plan Sponsor: the employer or union who provides the plan
- Summary Plan Description: summary of the benefits under a particular plan, including what the benefits are, how to apply for benefits, when and how benefits are distributed, and how to appeal if benefits are denied.
- Welfare Benefits: any benefit that is not a pension benefit, such as disability, health, or life insurance
ERISA Disability Claims
Disability insurance is intended to compensate you in the event that you become injured or ill and can no longer work. If you have disability, health, and pension benefits through your job, they are probably regulated by ERISA (the exception being government employees). Unfortunately, as happens with other types of insurance disputes, insurance providers attempt to increase their profits by wrongfully denying disability claims even when the insured is clearly unable to work and is entitled to benefits.
If your ERISA disability claim is denied by your insurer, you may appeal the decision. There are several crucial elements of the appeals process. First, you must file your appeal in a timely manner (e.g. within 180 days or the time period set forth in your denial letter and/or insurance policy). It is important to provide as much evidence of your disability as possible, including evidence and testimony from your physician(s) that explains the nature of your disability.
Also, it is appropriate for an appeal to include a letter from your ERISA attorney to the claims representative, outlining the additional evidence that has been provided, the insurer’s misinterpretation of the policy, any instances of non-compliance with federal requirements, and other relevant pieces of information. Because a reviewing court typically only overturns a claim denial if the insurer’s behavior is deemed “arbitrary or capricious” (i.e., shows an abuse of power), it’s important to submit any evidence of such conduct at this time.
The insurance company has 45 days to respond to an ERISA appeal. They may request a 45-day extension, provided they give you notice. It is required that you be notified of the decision made about your appeal. If your claim is denied, the insurer must explain – in language that you can understand – the reason why it was denied and the rules of the plan upon which the decision was made.
If you have questions about the ERISA appeals process, contact attorney J. Todd Tenge of the Boulder, Fort Collins, and Denver areas, to schedule a free, confidential consultation.
In the event of your ERISA administrative appeal is denied, you have the option to pursue litigation. Cases are normally handled in federal court, primarily because federal law supersedes state laws in ERISA disputes. A judge will review your case, including your claim’s administrative record and the arguments made by each side’s counsel, before arriving at a decision. You will not be allowed to add any new evidence at this time into your administrative record, so it’s best that you make the most of the appeals process, during which you can fill your record with information to support your claim and persuade the judge to overturn the original decision.
Because of the nature of ERISA litigation, it is highly recommended that you seek the counsel of an experienced ERISA attorney early in the appeals process. J. Todd Tenge has 20 years of experience handling complex ERISA claims and appeals. His expertise and experience increases the chances of a favorable outcome.
The court will apply either the “arbitrary and capricious” or the de novo standard of review. In the former, you must prove that the claims reviewer who denied your claim behaved in a way that abused his or her discretion. In the latter, no weight is given to the claim reviewer’s decision, and the court makes its own judgment based on the evidence presented.
If your ERISA litigation is successful, you may recover the amount of past-due benefits, and possibly interest. You may be awarded attorney’s fees by the court, but you will not be eligible for punitive damages, nor damages for pain and suffering.
Begin Your Claim Now – Contact Our ERISA and Long-term Disability Insurance Attorney in Boulder and Fort Collins
If you have questions about filing an ERISA claim or appealing a denial, please contact attorney J. Todd Tenge in the Boulder and Fort Collins areas to discuss your legal rights during a free, personal consultation. Mr. Tenge can help you navigate the complicated legal process and aggressively advocate for you in court.