One of the most frustrating facts for claimants fighting a disability insurance company’s denial of their LTD claim is learning that they are not entitled to their day in court in front of a jury of their peers. When their financial future is at stake, it seems wrong that the insurance company is not only in charge of the administrative process to review their claim but there’s no way to go before an impartial judge.
We think the deck is stacked against the claimant, and that’s part of what drives us to represent our clients as aggressively as possible: we want to see our clients get justice.
If you scour the web, you will find the occasionally exception to the ERISA no-jury rule, but they are just that: exceptions.
Here’s what you need to know about ERISA and why you can’t get a jury trial with an ERISA disability claim:
ERISA is the acronym for the Employment Retirement Income Security Act of 1974. As described on the US Department of Labor website, ERISA is a federal law that sets minimum standards for most voluntarily established pension and health plans in private industry to provide protection for working Americans. It is used to govern how plan information is shared with employees, outlines fiduciary responsibilities for those who manage and control plan assets and requires plans to establish a grievance and appeals process concerning individuals who want to receive benefits from their plans.
At its essence, ERISA was originally designed to protect the benefits of working Americans from having their benefits and retirement accounts taken by employers or others. But today ERISA is used to control the appeals process.
When your disability claim is being processed, every document that you and your doctors send to the insurance company becomes part of your claims file. Those documents are the only documents that the administrative judge will review if you need to file an appeal. They are very important in fighting for your disability benefits.
With the increasing use of portals to share information, claimants often are eager to get their claim started. They create an account with their long term disability insurance company, start filling out online forms and sending documents. If their physicians’ office has a portal and makes medical records available, it seems easy to just download the documents and send them along.
That’s where claimants often get into trouble with their disability claims. They don’t know that there is certain language that the disability claims reviewer is looking for. Or that there are certain disabilities that send up big red flags and can immediately prompt a closer look by claims examiners.
At Frankel & Newfield, our understanding of how ERISA applies to disability claims and our experience with the documents, particularly medical records, that are scrutinized by claims reviewers, helps our clients by getting the information right early on in the process.
If you have questions about how your documents are going to be reviewed, we hope you’ll call our office today at 877-LTD-CLAIM (877-583-2524) and learn about potential pitfalls in the disability claims process.