Camden County New Jersey Disability Attorney
Many people buy long term disability insurance, either on their own or through their employer. This is separate and apart from Social Security Disability, which is paid by a worker in the normal course and taken out of their paycheck. Long term disability is necessary to protect workers in case they get hurt and can no longer work. There are certain laws that govern this type of long term disability insurance. Many times the insurance company will cut off, stop, or terminate payments to the person who has the policy. Once benefits are terminated, there are often appeals that need taken within the actual disability company. Because the insurance company is looking to, or has stopped paying benefits, the person should consider hiring a long term disability lawyer to protect their rights and fight the insurance company. Most of these plans are governed by ERISA. What does that mean?
ERISA – the Employee Retirement Income Security Act – was intended to help employers manage pension plans more responsibly and effectively. Under the terms of ERISA, additional reporting and accounting requirements were instituted to create more transparency in the hopes of reducing fraud and financial mismanagement in connection with pension funds. ERISA, however, is a federal act; as such, it takes legal precedence over state laws that often provide greater protection and security for disabled employees than the terms of ERISA alone.
Unfortunately, due to the legal precedence ERISA takes over state law, some insured plans have leveraged ERISA to reject long-term disability claims. Practically speaking, this means employers who do not want to carry the costs associated with disabled employees can more effectively contest long-term disability claims under ERISA.
ERISA and Disabled Employees as Plan Participants
The first issue that must be considered is the fact that the terms of ERISA do not allow a claimant to a jury trial or punitive damages in disputes. Additionally, government plans offered to government employees are exempt from ERISA. Further, if you have private disability insurance, it is not covered under ERISA either. Finally, ERISA allows a plan administrator to determine if you are disabled according to the terms of an insurance policy and whatever medical evidence is submitted in your file. In this way, an employer may more effectively challenge long-term disability claims using the terms of ERISA instead of New Jersey state law.
Appealing ERISA Decisions
When a plan administrator denies a disability claim under ERISA, you are required to first complete a 180-day appeals process before taking legal action. Unfortunately, courts often give greater weight to the decisions of plan administrators, downplaying or setting aside medical facts associated with a case. In fact, plan administrators who want to control insurance costs often base their opinion on the advice of a single doctor. In the vast majority of cases, the doctor consulted isn’t the claimant’s primary physician or even a specialist.
Contact Camden County Disability Attorney Michael J. Dennin
The issues associated with disability claims and ERISA can be confusing. If you’ve encountered difficulty in dealing with your plan’s administrator or have been denied long-term benefits, contact Pennsauken disability attorney Michael J. Dennin today.