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Why You Need a Lawyer to Assist You with Your Long-Term Disability Appeal

June 15, 2018

The laws that govern employer provided long-term disability appeals is a complex area of insurance law that becomes very confusing when filing for disability. The attorneys at Murray Law Office are well-trained in ERISA and can make the process less stressful and advocate effectively on your behalf.

When you are injured/ill/sick and unable to work, one would think that you should be able to rely on your long-term disability coverage through your employer. However, instead of focusing on your health and recovery, the claim process when filing a disability claim is a confusing, stressful, and complex ordeal that can add to your stress when undergoing a major life change. When filing your claim against the insurance company, you may potentially run into a number of issues that could limit the amount you receive and/or jeopardize your ability to recover ANY money from your insurance carrier.

While each case is unique, retaining a Long-Term Disability Attorney can be very helpful to succeeding with your claim when you are up against a large insurance company who has a team of specially trained adjusters, doctors, and attorneys fighting against you. If you become disabled, you should hire an attorney well-versed in ERISA because:

  1. We will help you determine whether your policy is governed under ERISA or State Laws.

There are two types of law that govern short and long-term disability policies: ERISA and State Law. ERISA (Employee Retirement Income Security Act) is a federal statute that governs short and long-term disability claims as well as employee benefit plans. ERISA can be extremely unfair to claimants as many policies contain a contractual provision which substantially increases what you are required to submit to demonstrate your eligibility to benefits. Further, these policies can be filled with a plethora of loopholes and exclusions where your insurance company is not legally required to pay you anything even if you are legitimately disabled. To make matters more confusing, while most employer provides policies are governed by ERISA, some can be exempt if your employer is a religious organization, governmental entity or agency.

If not governed under ERISA, your long-term disability policy is most likely governed under State Law, which tends to be much fairer and is not fraught with the number of loopholes and exclusions found in most ERISA policies. However, even if your policy is not governed by ERISA, your insurance company may still assert that it is governed by ERISA, sometimes using specific ERISA language. Because of this, we urge you to speak to a trained ERISA lawyer at Murray Law Office. We will help you determine whether your policy falls under ERISA law and what legal ramifications it will mean.

  1. We will help you determine your legal remedies and how to strengthen your appeal.

Clients bear the burden of proof, and as a result, an insurance company has no obligation to make your case for you. While the insurance company may seem helpful and will sometimes try to gather information for you when you ask to appeal, they will not tell you how to strengthen your case nor can you blame them if, in retrospect, you could have submitted proper information to support your claim but they failed to gather it for you.

When you are denied, it is your responsibility to prove why the insurance company's decision was wrong AND (in most cases) why their decision was unreasonable and not supported by even a scintilla of evidence. Determining your legal remedies and arguments requires a complex analysis of your medical records, policy, the claim file, and a myriad of cases that have been previously decided across the country where prior courts have issued rulings interpreting the reasons the insurer relied on when terminated or denied your claim as applied to the specific facts of your case. The attorneys at Murray Law Office will analyze your case so that we prepare appeals properly and aggressively advocate on your behalf.

  1. We will make sure to introduce all evidence in time.

ERISA guidelines have strict deadlines and guidelines that employees need to follow, at the risk of losing eligibility for benefits. If your long-term disability claim under ERISA is denied, you must navigate through a complex appeal process. Further, ERISA has an Exhaustion Requirement where you can waive arguments if you fail to raise them in your appeal or submit the appeal on a timely basis. To make matters even more unfair, once you have submitted your appeal, you are not allowed to introduce any new information once the insurance company has made a final decision if they deny you again when you seek the court's help following a final decision.

Unfortunately, too often clients have often come to us after they decided to do their own legal work and their appeal has been denied, only to find out that they have exhausted their remedies, failed to submit what is required of them pursuant to the case law, and severely limited or prohibited the money they should have received if they decided to seek competent representation before appealing. Murray Law Office will ensure that all deadlines are met and all avenues of recovery have been considered.

Given the complexity of short and long-term disability insurance claims, you should contact a competent ERISA disability attorney like the ones at Murray Law Office if you are in need of help when you are denied and before you appeal. Even if you have not been denied, the short and long-term disability attorneys at Murray Law Office like to speak to clients as early as possible to warn them of many of the unknown surprises many clients run in to when filing a short and long-term disability claim on their own. We always provide a free initial consultation as we love educating our clients on how these claims work, warning them from the inception of their claim about the loopholes and exclusions which may be unique to the facts of their particular cases and disabilities that may limit their recovery, and (hopefully and most importantly) develop strategies to beat their insurance company.

If you are interested in a free consultation or want to speak to one of short and long-term disability attorneys at Murray Law Office.