Disability Insurance Blog

Man claims wrongful denial of benefits in violation of ERISA

erisa disability appeals

Friday, December 8th, 2017

No one in America is guaranteed good health. While everyone will get their fair share of minor colds and injuries, leading them to miss a couple days of work, some are not so lucky and will suffer from a serious illness or injury that causes them to miss work for an extended period of time.

This is when having long-term disability insurance can be essential. Long-term disability insurance is often a benefit provided by a person’s employer, but it is possible for a person to purchase an individual policy if one is not offered by their employer. These policies provide compensation for those who cannot work for an extended period of time due to a major illness or injury. While this compensation may not match exactly what a person would earn if they were able to work, it can still be vital to help the person make ends meet financially while they recover.

Unfortunately, sometimes insurers will wrongfully deny a person’s claim for long term disability benefits. Sometimes, this denial violates the Employee Retirement Income Security Act, and the policy holder will, thus, sue the insurer.

For example, in one recent case, a person has filed a lawsuit against Prudential Insurance, claiming that the insurer breached its duty of good faith and fair dealing. According to the lawsuit, the policy holder has incurred significant monetary damages because he was denied long-term disability benefits. He claims that the denial went against the terms of the plan and that he was denied benefits even though his health care providers determined the benefits were necessary. He also claimed that the insurer did not execute a full and fair review of his claim for benefits.

While time will tell how this man’s claim will play out, it is a good example of how a person sometimes needs to take legal action if they are wrongfully denied benefits. Suffering a serious injury or illness is bad enough; those who have long-term disability insurance policies should not have to suffer the stress of a denial of benefits. An attorney experienced in ERISA disability appeals can help in such situations.