When A Disability Plan Administrator Or Employer Has Wrongfully Denied You Benefits
Ask an ERISA attorney to help you understand and respond to a denial for short-term or long-term disability benefits through an employment-based insurance plan governed by the Employee Retirement Income Security Act of 1974 (ERISA). You may discover that the denial is not as cut-and-dried as the plan administrator implies that it is. The denial may have a number of explanations, legal or illegal.
You may assume that a denial of benefits has to do with definitions or documentation of your disabilities. These may not be the real problem. A close examination of the facts may reveal that the denial is unjustified for other reasons. Attorney Reagan Toledano at Toledano Disability Law can help you identify the true reason(s) for the denial of the claim and prepare to fight back on your behalf.
Legitimate And Wrongful Reasons For Denials Of ERISA-Governed Benefits
The following summaries of reasons for the denial of your benefits claim may provide insight into the many pathways for appeals.
- A plan administrator may disagree with your explanation of your disabilities. Perhaps the documentation is incomplete or unconvincing. These objections may or may not be justified. If you appeal, you can include more complete medical records and other evidence to show that you are temporarily or permanently disabled.
- A denial may be wrong on the basis of processes rather than substance. That is, the plan administrator may fail to comply with the standards, rules or timelines prescribed by ERISA for benefit plans. Your legal remedy, in this case, may be to pursue internal appeals and/or bring a lawsuit against the plan with an emphasis on noncompliance.
- Your denial of disability benefits may originate with your employer. If you can show that your employer discriminated against you on the basis of your medical needs or retaliated when you applied for disability benefits, you may have a reason to bring a legal claim or lawsuit against the employer.
- The plan administrator may have breached their fiduciary duty. An experienced ERISA attorney can conduct discovery to determine if, and how, this happened.
Do not assume that a simple denial letter is the end of the story. Consult with an ERISA lawyer to explore all explanations and options for overcoming claims denials.
Request A Review Of Your Denied Claim
Reagan is available to advise individuals as well as attorneys. He can answer your questions and determine how you can fight back after your benefits claim has been denied. Since 2005, he has been helping people overcome denials of disability and life insurance claims relevant to ERISA.