The second article on disability insurance law in our series for Dentist’s Money Digest explores the issues facing dentists who... Read more →
Advocates for ERISA Appeals of Denied or Terminated Claims
Where a group disability claim has been denied or terminated, we prepare a thorough appeal of the claim to the insurance company. Our goal is to have the insurer reverse its decision and provide benefits. These claims are typically governed by ERISA (Employee Retirement Income Security Act) and are complex in both substance and procedure.
The ERISA appeal process includes the development of medical, occupational, factual and legal support for the claim. This serves two purposes: first, to convince the insurer to reverse its denial of the claim, and second, if that does not take place, the appeal becomes the foundation of documenting and strengthening the administrative record that a court will review if we are forced to litigate a claim.
These appeals are vital to protect you, since once the administrative appeal process is completed, and a lawsuit must be commenced, policyholders generally do not have any other opportunity to support their entitlement to benefits. Thus, the appeal is the only avenue to create a record that can support the reinstatement of benefits. Litigation of these claims are almost always limited to the record before the insurer, so the quality of preparation of the appeal is vital to a successful outcome.
Management of Long Term Disability (LTD) Claims
The firm handles clients' initial claim filing, gathering medical and occupational support for the claim. We work with the client, the treating physician and, where appropriate, financial professionals to develop appropriate support.
We manage the entire claim process, including addressing the insurance company's request for additional information and/or requests for examinations, Functional Capacity Evaluations (FCE), and field visits and interviews. In this way, we are able to spot issues before they become claim problems. Engaging the firm at the outset is always the best strategy, since we can anticipate and preempt claim concerns that can potentially harm a claim.
Litigation of Private and ERISA Long Term Disability (LTD) Policies
Where appropriate and necessary, the firm initiates lawsuits on behalf of aggrieved policyholders and beneficiaries throughout the country to recover their denied or terminated benefits.
The firm aggressively pursues all available claims and remedies, and relentlessly attacks all avenues of discovery in litigation. Our reputation among the insurance community as aggressive litigators is a benefit to our clients, as the insurers often seek early and favorable resolutions.
Negotiate Settlements & Buyouts of Long Term Disability (LTD) Policies
Where advantageous to the client, the firm addresses the feasibility of negotiating a buy out of the remainder of the client's claim, developing a resolution platform that explores the future exposure to the insurer, examines the present value of the future exposure and analyzes future claim risks to both the client and the insurer.
The firm also engages in non-litigation alternative dispute resolution with the insurers, effectuating settlements of denied or terminated claims without costly and time consuming litigation.
Litigation of Bad Faith Insurance Claims
The firm has successfully represented clients in bad faith claims against long term disability insurance companies when the insurance companies breach the legal covenant of dealing with policyholders in a manner that is fair and in good faith.