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If you receive long-term disability (LTD) insurance as an employee benefit through work, it’s likely that your benefit is governed by the Employee Retirement Income Security Act, also known as ERISA. ERISA is a federal law that applies to all sorts of employee welfare benefits, including health insurance, life insurance, short-term disability insurance, and LTD insurance.

Very generally speaking, if you need to make a claim for LTD benefits, you will be required to go through a claim process with the insurance company. Here are five tips to help make sure you are providing the insurance company with the information it needs for your claim.

1. Explain why you can’t work. This may seem obvious, but you will need to provide specific information about why you are unable to continue working. While an off-work note from your doctor might be sufficient for an excused absence with your employer, the insurance company may need additional information about why you can’t work. Be sure to gather and submit medical records and results from any diagnostic tests. Also, many insurance companies will provide you with fillable forms for you and your doctors to use to explain the basis of your disability.

2. Make sure to get all your information submitted. It’s important to make sure you have provided the insurance company with all the information it needs to make a decision on your LTD claim. If your claim or appeal is denied, you may not be able to submit additional information after the decision is made. As a result, it is imperative to provide all medical and vocational records before the claim process is over.

3. Pay attention to deadlines in letters from the insurance company. ERISA and its regulations set forth certain time limits for both you and the insurance company to follow during your LTD claim. If an insurance company denies your claim, it is required to give you notice of the amount of time you have to submit an appeal. Be sure to get your information submitted before the deadline passes.

4. If the insurance company gives you an opportunity to submit information in response to a medical report it has obtained, take the opportunity to explain your claim. Insurance companies might hire their own doctors to either examine you or to perform a review of your medical records. If the insurance company provides you with a copy of the report before finalizing its decision on your claim, be sure to review the report and submit any additional information.

5. Send in statements from co-workers or family members. Your medical records most often will have information about your medical conditions and why you are unable to work. If you have a co-worker or family member who can explain through firsthand knowledge how your medical conditions are affecting your ability to work or to complete activities of daily living, you can submit statements from those individuals in addition to your medical proof.

If you have questions about your long-term disability claim, contact the attorneys at Mehr Fairbanks Trial Lawyers. Philip Fairbanks, Esq., one of the partners at Mehr Fairbanks Trial Lawyers, wrote this piece. We hope this was helpful, and please get in touch with our firm if you have questions.

Most health insurance plans cover medical expenses if the treatment is medically necessary and not “experimental” or “investigational.” But the health insurance policy documents rarely spell out exactly what treatments the insurer considers experimental or investigational. Instead, health insurance companies will create separate “medical policy guidelines” that their claim examiners will use to approve or deny claims. These medical policies can result in a large number of claim denials if the insurance company has put in place a policy that denies all requests for a certain type of treatment.

If you get your health insurance coverage through your employer (or a family member’s employer), your insurance is likely subject to the Employee Retirement Income Security Act (ERISA). ERISA is a federal law that provides claimants and beneficiaries with a civil enforcement scheme to remedy wrongful denials of coverage.

Under ERISA, a claimant can file a lawsuit to enforce and/or clarify his rights to the benefits at issue. ERISA also allows a claimant to seek declaratory or injunctive relief if a particular medical policy is not consistent with current medical standards. In other words, if a medical policy is faulty and not based on prevailing medical standards, a claimant can ask a court to require the insurer to reprocess a claim using a corrected medical policy. This type of claim reprocessing is a common remedy under ERISA, and courts have the authority to order claim administrators to reprocess claims.

Accidental Death and Dismemberment (also referred to as AD&D or ADD) insurance is a type of life insurance that may provide additional coverage to you and your family if a death is the result of an accident. This means your beneficiaries may be able to recover life insurance proceeds plus additional accidental death proceeds.

While this insurance can be an added benefit, it also has its own exclusions and limitations. Whether a death is an accident or not may sound like a simple enough concept, but insurance companies may still attempt to deny a claim for a variety of reasons such as suicide, intentionally self-inflicted injury, war, inhalation of poisonous gases, commission of a criminal act, use of alcohol or drugs, overdose, or death caused by a disease or sickness. Consider the following: an individual is involved in a motor vehicle accident and tragically dies. Almost universally, everyone would agree the death is the result of an accident, but what if the driver had taken medication that day? What if the driver was speeding? What if the driver had a heart condition at the time of the accident? Another example: someone has an adverse reaction to a medication and unexpectedly passes away. This also would vastly be considered an accident, but what if the person was prescribed too high of a dose? What if the medication reacted with another substance? What if the person had a preexisting medical condition?

Issues like these can make what seems like a straightforward question (accident or not?) more complex. If you have had a claim for life insurance or accidental death insurance denied, contact us for a case evaluation. Many people get their AD&D policies as an employee benefit through their employer. As a result, your insurance claim may be covered by the Employee Retirement Income Security Act (ERISA). Our team of attorneys has decades of combined experience counseling clients and getting results. We have handled accidental death insurance lawsuits for beneficiaries in state and federal court.

Mehr Fairbanks Trial Lawyers teamed up with The Carnegie Center for Literacy & Learning to raise money for their tutoring services. You can read more about the fundraising project here.

Mehr Fairbanks Trial Lawyers promised to match up to $10,000 of any contribution made to the fundraiser. Thanks to several thoughtful donors, MFPTL was able to donate the full $10,000 amount. Pictured below are members of the MFPTL staff and members of The Carnegie Center staff exchanging the $10,000 check, while staying socially distanced. Combined with MFPTL’s contribution, the fundraising campaign raised a total of $26,270 for The Carnegie Center’s tutoring program.

At Mehr Fairbanks Trial Lawyers, we strive to help the community in any way that we can, whether that’s by settling cases for our clients or donating to a fundraiser that is important to our team to help students in our area. We are dedicating to helping you!

Attorney Bartley Hagerman recently settled a premises liability case for $100,000. Our client slipped and fell on ice in a parking lot after getting out of her car and sustained bodily injuries. The lawsuit was settled with the property owner and the snow and ice removal company.

If you or someone you know suffered bodily injuries following a similar incident, click here and begin speaking with one of our attorneys. Our attorneys have years of experience helping our clients recover money that they are entitled to following personal injury and premises liability cases.

Call us today!

Austin Mehr will be presenting on the topic of Insurance Bad Faith Litigation on Friday, July 17, 2020 beginning at 1:00 p.m. EST. Austin will be presenting along with attorneys Buddy Wheatley and Claire Parsons. Due to the COVID-19 pandemic, the session will be held via Zoom. Mehr was invited to present in this CLE session earlier in the year and looks forward to participating and sharing information on bad faith.

The CLE has been approved in three states (Kentucky, Ohio and Indiana) for three hours, including one ethics hour.

Austin is looking forward to seeing all of the virtual attendees!

Did you know that some state governments look at the reading levels of 3rd graders to plan prison capacities in the future?

By teaming up with The Carnegie Center for Literacy & Learning, we can help close the achievement gap that exists with children in our community. It starts with learning to read well.

Carnegie helps struggling children learn to read better. They have two reading specialists on staff, both educators, that assist with children in our community who fall behind in learning to read. The Carnegie after school tutoring program offers tutoring sessions to disadvantaged students with a one-time fee of $5 to enroll in the programs. Without resources available to help them read, they will fall behind in school, and their life opportunities will change forever.

The coronavirus pandemic has led to many events being postponed or canceled all around the world. In many cases, this is considered bad news for all involved. Workplaces deemed nonessential have been closed for nearly two months waiting on this period of life to pass. Fortunately, our office’s mission is still to help our clients and to be available as much as possible during this time.

To our current clients and to those seeking our services for short-term and long-term disability claims and appeals, it is important to note that we are still here to help you every step of the way. Because of the National Emergency we are all enduring, current deadlines to file claims and to submit appeal letters following the denial of a claim under ERISA have been tolled until the pandemic is resolved. According to the Employee Benefits Security Administration (EBSA), Department of Labor:

All group health plans, disability and other employee welfare benefit plans, and employee benefit plans subject to ERISA or the Code must disregard the period from March 1, 2020 until sixty (60) days after the announced end of the National Emergency or such date announced by the Agencies in a future notification (the “Outbreak Period”) for all plan participants, beneficiaries, qualified beneficiaries, or claimants wherever located in determining the…time for making a claim for benefits or appealing the denial of a claim for benefits.

This means that if your appeal deadline falls within the time frame listed, you have an additional sixty days to file initial claims and to submit appeal letters following the denial of a claim from the date of the lifting of the National Emergency.

Attorney Bartley Hagerman successfully got a client’s Long-Term Disability benefits reinstated with The Hartford. Before reaching out to our office, the client had been denied long-term disability benefits from his insurance company. Attorney Hagerman’s appeal succeeded, resulting in The Hartford reversing their denial and putting our client back on claim to receive monthly benefits.

At Mehr Fairbanks Trial Lawyers, we strive to help all of our clients in various types of cases. For long-term and short-term disability cases, we are here to help you before, during, and if needed, after the appeal process to help you get all of the benefits that you are entitled to. We are dedicated to helping you against all of the major insurance companies. For a full list of insurance companies we have worked with, click here.

If you or someone you know has been wrongfully denied benefits for long-term or short-term disability benefits, don’t wait. Contact us today to see what we can do to help you with all of your needs. Click here for a free case evaluation or call us now at (800) 249-3731.

Each benefit claim is different depending on the facts of your case, the plan, and the benefits at issue. However, below are some frequently asked questions regarding ERISA disability claims. If you have further questions or your long term disability or ERISA disability claim has been denied, contact one of our experienced ERISA disability attorneys for a free consultation today.

1. What is ERISA? “ERISA” means the Employee Retirement Income Security Act of 1974 – a federal law designed to protect employees who are enrolled in retirement or benefits plans through their employment. ERISA requires accountability of plan fiduciaries and generally defines a fiduciary as anyone who (1) exercises discretionary authority or discretionary control over a plan’s management or exercises any authority or control respecting management or disposition of its assets, (2) renders investment advice for a fee or other compensation, direct or indirect, with respect to any moneys or other property of such plan, or has any authority or responsibility to do so, or (3) has any discretionary authority or discretionary responsibility in the administration of such plan. In addition to keeping participants informed of their rights, ERISA also grants participants the right to sue for benefits and breaches of fiduciary duty.

2. Who controls ERISA? According to the Department of Labor, there are three separate bodies that administer and enforce ERISA: the Employee Benefits Security Administration, the Internal Revenue Service, and the Pension Guaranty Corporation.