Insurance companies that issue long-term disability policies governed by the Employee Retirement Income Security Act of 1974 (ERISA) have many responsibilities to policyholders. Insurance company employees generally need to act in the best interests of policyholders due to a fiduciary duty imposed by the law.
Businesses also need to allow an appeal if they reject a long-term disability benefits claim and the policyholder disagrees with their decision. Despite those rules, people may still find themselves unable to get the coverage they require when dealing with a disabling medical condition. In some cases, they may have grounds to take legal action. Current rules allow for civil relief when people have denied ERISA disability benefits claims.
What do people need to know about that court process?
Existing evidence is all that they can use
Oftentimes, other types of litigation or appeals may allow for the introduction of new evidence or documentation. That is not the case in an ERISA long-term disability benefits lawsuit. The courts typically can only consider the information that the insurance company had available for processing the claim and the appeal. It is therefore crucial for people to gather sufficient documentation during the appeals stage so that the courts have information to review if they must file a lawsuit.
A jury trial is not an option
Often, those pursuing lawsuits have the option of asking to have their case heard by a judge or by a jury. That is not the case for an ERISA lawsuit. Typically, a judge hears such cases and issues summary judgment. They look at the information available to the insurance company, the terms of the policy and the rules of ERISA to determine whether the business violated the law or its duty to policyholders.
Taking legal action over an ERISA disability claim denial is a lengthy and technical process. Appeals are more likely to be successful when individuals understand the law and have someone assisting them with the process. Navigating an ERISA appeal or a lawsuit after a failed appeal requires precision and patience. Those who secure the right support can focus on the other challenges they face rather than the technicalities of an ERISA appeal or a complex civil lawsuit.