ERISA-Governed Appeals Myths, Truths, And What You Can Do

The myths about ERISA disability claims, and the truth about these claims.Myths:

  1. Hiring any lawyer will help you to win your appeal. 
  2. You should hold back your best evidence for trial so that you can hit the insurance company when it counts.
  3. You will be able to present your case before a jury of your peers. 
  4. You can count on your doctors’ testimony to convince the judges that you deserve benefits. 
  5. You will get on the stand in court to show and tell the judges how you are disabled and how the insurance company wronged you. 
  6. You may petition for compensation for any problems this wrongful denial of benefits has caused you, whether that was simply time they wasted or if the denial of benefits cost you your health insurance, which put you into debt or forced you to forgo treatment you needed, leaving you with additional medical problems or financial troubles.
  7. If the judges find you disabled, they will make the insurance company pay benefits. 

Truths:

  1. ERISA governed appeals are not argued like any other disability insurance appeal. Most lawyers are not trained in ERISA law and would either do a poor job on your appeal or charge you significantly more for the time (of which you do not have much!) to learn enough about ERISA law to successfully appeal your case. 
  2. You will not be allowed to introduce new evidence in the trial. All the judges will be looking at is whether the insurance company responded appropriately to the material you sent in your initial claim and appeal.
  3. There will be no jury. There will be no trial. Your lawyer will make the case to a judge, who may or may not be familiar with ERISA disability law. 
  4. Again, because there is no trail, no one will testify. No jury will listen to your doctor. All that you can call upon is the documentation previously submitted by your doctor for the initial application and the appeal. 
  5. You will not be able to speak to the judges. Your lawyer is the only one who gets to do the talking. 
  6. Under ERISA law all that any insurance company will ever pay are the benefits you were owed and your attorney fees. You will never get compensation for any other issues their wrongful denial of benefits caused you—no matter how huge. 
  7. Your case in court is not about whether you were disabled or not. It is about whether the insurance company did anything wrong. Under the better standard—de novo review—the court is deciding if the insurance company made the correct decision about your disability with the information it had at the time. Under an abuse of discretion standard of review, the court merely decides whether the insurance company can reasonably justify its denial of benefits. The court may agree that you are disabled and still decide the lawsuit against you. 

What You Can Do:

  1. Hire an attorney who is experienced in ERISA disability insurance cases. Read their reviews, which tell a lot about a lawyer. You can find ours by searching “Ben Glass Law” under the Lawyer Directory on avvo.com.
  2. Wait to submit your initial claim until you have all the tests and results that your physician recommends. If you have been denied, check again with your physician and make your case as strong as possible medically before submitting your appeal. With your appeal, however, you should additionally submit evidence that the insurance company was unreasonable in denying your claim the first time. This is where an ERISA disability insurance lawyer can make your case significantly stronger. 
  3. Hire a lawyer who is experienced in ERISA disability cases. Your lawyer will likely be teaching the judge how to rule on these kinds of cases. 
  4. Make sure you get ALL of your medical evidence in during the appeal stage! This is your doctor’s last chance to go to bat for you. 
  5. Hire an awesome ERISA disability lawyer! They are doing all the talking so you want someone who will both do great job and make sure that you are on board. 
  6. Understand exactly what your policy covers before filing a claim. Have all your ducks in a row before filing your initial claim to minimize the chance that they deny your claim. Go to an experienced ERISA attorney before filing your appeal to give your claim the best chance of being approved that second time instead of having to wait even longer to go through a lawsuit. 
  7. Hire an experienced ERISA disability attorney. Starting with your appeal they will build a case showing not only that you are disabled but also that the insurance company has acted unreasonably—the argument the court will use to decide if you win.
Ben Glass
Ben Glass is a nationally recognized Virginia injury, medical malpractice, and long-term disability attorney