Is It Worth Hiring A Houston Attorney For Long-Term Disability?

August 14, 2018 by

Filing for long-term disability is a long and challenging process. It’s more than filling out a few forms and checking items on a list. Medical evidence, information from your employer and other documents are part of what will win or deny your case. Insurance companies have strict deadlines, and one small mistake can see your entire claim denied.

Is It Worth Hiring A Houston Attorney For Long Term Disability?

They Don’t Want To Pay You

Insurance companies would rather you didn’t realize that even though you’ve paid into their policy, they’re not interested in helping you. Paying claims is not a good business model, so insurers make sure that there are multiple ways to deny your claim. Short deadlines, excessive or duplicate paperwork, delaying claims or payments or giving lower payments than indicated in the policy are all ways insurers stall. Legitimate claims for disability are increasingly denied for the slightest reason. Knowing that most people don’t have the means to fight back, these “bad faith” practices continue with little pushback.

ERISA

The Employee Retirement Income Security Act of 1974 was enacted to protect employees, but ends up protecting insurance companies. Instead of protecting you, ERISA gives insurance companies greater freedom to deny your claim. Although the Department of Labor says that it “protects retirement savings from mismanagement and abuse,” insurers are free from many state-level restrictions on bad-faith insurance practices. Insurers are then are free to decide who is approved for LTD benefits, and who isn’t.

The deck is actually stacked against you as an applicant, and it’s up to you to be able to make sure your claim is completely correct. This is where an attorney can help make sure your application is not only correct, but more than sufficient to prove your claim and make it harder to deny.

If you decide to handle your ERISA appeal without an attorney, you’ll more than likely be denied, and you could lose any additional opportunities to appeal or file a suit. You may only have one chance at an appeal.

Hiring An LTD Attorney

Of course, you want to find an attorney in Houston who has experience with both LTD claims and with ERISA appeals. He or she will understand the process and know exactly how to follow the rules.

If you hire an attorney at the beginning of your application process, he or she knows that ample evidence in your administrative claim will help meet and exceed the insurer’s requirements. If you just fill out the paperwork on your own, and depend on the insurer to find all the evidence it needs, there’s a strong chance your claim will be denied because of insufficient information, or even a mistake.

Once a decision has been made, no new evidence is allowed. An experienced LTD attorney will know exactly what to add to the claim to increase your chances of approval. Should your claim be denied, having an attorney will increase your chance of winning an appeal, and you’ll have a good stack of evidence available to better prove your claim.

Your Houston LTD Disability Attorney

ERISA claims are a complex area of the law, and there aren’t many attorneys in Houston—or Texas—that handle it. The Herren Law Firm can help you with your application as well as any appeals to help you get the long-term disability benefits you need to take care of yourself. Contact us today at 713-682-8194 to schedule your free consultation. There’s no obligation and no up-front fees.  We only collect if we win your case.

Filed Under: Long Term Disability Tagged With: , ,

What is ERISA and How Might it Affect My Long Term Disability Claim?

February 22, 2018 by

ERISA is short for Employee Retirement Income Security Act, established in 1974. It’s is a federal law under the US Department of Labor that “sets the minimum standards for most voluntarily established pension and health plans in private industry to provide protection for individuals in the plans.”  Unfortunately, it doesn’t always work that way.

What is ERISA and How Might it Affect My Long Term Disability Claim?

ERISA governs long-term disability policies and only applies to most private employers that offer benefits. It was created to ensure that plan administrators didn’t misuse pension and other employee funds. Public (governmental) or church employees (including church-owned hospitals) and private policies are excluded. ERISA only establishes minimum standards for employers who do offer benefits for their employees. It doesn’t require them to offer benefits.

ERISA And Long Term Disability Policies

A lot depends on what your company and the policy calls “disability.” Research your policy and find out exactly how yours defines it since it could determine if you can get LTD and for how long.

Some policies say “any occupation,” which means you’re unable to work at any job. “Own occupation” indicates that you can’t work in your current occupation, but you could work in a different one. (For instance, an injured construction worker who becomes a project manager.)  Some policies go from “any occupation” to “own occupation” after 24 months, meaning you could work another job, even if you can’t work in the one you had before.

Claim denials are common for even the most legitimate disability cases.

ERISA means that if your LTD plan is employer-funded if you should need to file suit, you will:

  • Have a hearing with judge, but no jury
  • Not be awarded attorney’s fees
  • Not be able to recover any damages
  • Likely to be ruled against in a court proceeding

Plan administrators are given considerable leeway in the administration of a plan.

How ERISA Can Keep You From LTD

It was intended to “protect” your rights, but ERISA ends up protecting the rights of the insurance companies. ERISA preempts most state law “bad faith” lawsuits, denying you the right to sue your insurance company should your claim be denied. Unlike a personal injury suit, where you can sue for damages, attorney’s fees and other compensation, ERISA prevents you from doing that. The most you can receive from a lawsuit would be the monies you were originally due when the insurance companies denied your claim to begin with. In the administrative hearing, the judges can only determine if the insurance company committed an “abuse of discretion.”

ERISA has complex rules and regulations that must be followed exactly, and deadlines that must be met without exception. Miss one deadline, or make one mistake in your claim, and the claim will be quickly denied without any opportunity to appeal or reopen your case.

Your employer may have additional requirements, with deadlines, for you to follow before you can access LTD. Ask for any and all related documentation so you can review it yourself. Deadlines and other requirements should be detailed in these documents, so read them carefully and take note of all deadlines you need to be aware of.

Your Doctor

When submitting your LTD claim, you’ll need to prove your disability. Before you file, you’ll need to have copies of all medical records, test results, X-Rays, your doctor’s communications with the insurer, and any other medical evidence related to your case. If you find errors in any of your records, write your doctor a letter and request that they be corrected.

If your doctor declines to help you in your disability case, find another one. A doctor who does support you in your claim can’t guarantee a successful outcome. But a doctor who doesn’t support you can easily sink your claim.

Submit All Evidence In Your Original Claim

Should your case proceed to federal court, you will NOT have the opportunity to submit additional evidence. The judge is limited to whatever is in your claim file. Neither you nor your doctor will be allowed to testify. Make sure that all relevant evidence—medical reports, testing, expert opinions, evaluations, etc.—is included in your claim. Include more favorable evidence than you think you need while the claim is open to ensure it’s complete.

Deadlines Count

Insurers have specific deadlines for filing claims as well as appeals. ERISA appeals are complex and detailed.

The Herren Law Firm can help you with your application, appeals and help you get the long-term disability benefits you need. Contact us today at 713-682-8194 to schedule your free consultation. There’s no obligation and no up-front fees.  We only collect if we win your case.

Filed Under: Veterans Disability Tagged With: , , ,

What is ERISA and How Does It Affect My Long Term Disability Case?

November 23, 2016 by

ERISA & Long-Term Disability Claims Attorney | Houston TX Herren Law

ERISA is an acronym for the Employee Retirement Income Security Act, and ERISA is a federal law originally designed to protect workers from the possibility of bankrupt pension plans. Additionally, ERISA included provisions regarding disability and long-term disability. One of the most important distinctions of ERISA, compared to long-term disability plans, is that ERISA only really applies when you receive a plan offered by private employers (not churches or government organizations).

If you’re unsure of how ERISA affects your long term disability (LTD) case, and you’ve suffered a disability that prevents you from working, make sure to call Houston LTD benefits attorney William Herren as soon as possible. Whether you’re in the beginning stages of preparing your claim, or you’ve received a benefits claim denial and you need to appeal the decision, we at Herren Law boast the resources and legal know-how to give you a strong, thorough representation. We work on a contingency basis, which means that we won’t accept a fee unless you win your case with us by your side. To speak with Houston attorney William Herren, call Herren Law today at (713) 682-8194.

In the meantime, you can learn more about ERISA and LTD claims below.

Understanding Long Term Disability and ERISA

As mentioned above, ERISA applies to employer-provided insurance policies. If you have purchased long term disability insurance directly from an insurer (rather than receiving it as an employee benefit), then ERISA probably doesn’t apply. In this case, the laws regarding your insurance plan will most likely come from the State.

Although the original idea for ERISA was to protect workers, it is now known as an extremely pro-insurance law. This is why you need to understand ERISA and your long term disability plan, as you need to be prepared for the claim process and how ERISA affects your disability benefits claim. For example, ERISA claims can be very drawn out. Before you’re able to file a federal lawsuit regarding your benefits claim, you will need to exhaust any and all processes with the insurer; this means that you will need to go through the in-house appeal process with your insurance carrier before filing a lawsuit with ERISA.

Furthermore, the time to appeal in ERISA cases is limited. After receiving a claim denial, you have only 180 days to appeal; after filing the appeal, your insurers will have up to 90 days to make a decision. This means that you’ll be in a “limbo” for up to 270 days, all while you’re disabled and unable to work and bring in an income.

How ERISA Affects a Claim for Long Term Disability Benefits

For employees of private companies, ERISA will probably apply to your long term disability case. Keep in mind that ERISA statutes are long-winded and incredibly complex, and how ERISA will affect your disability case depends on the unique circumstances of your disability claim and other factors. Nonetheless, with decades of experience as a Houston disability benefits attorney, we at Herren Law have witnessed a few ways that ERISA affects long term disability cases. Below, we’ve included just a few of these ways:

  • Following a denial of benefits, ERISA requires that the disability insurance plan must provide the claimant with copies of documents, records, and any other information that is relevant to the claim.
  • If a claimant fails to appeal within ERISA’s guidelines (180 days), then the claimant forfeits his/her rights to appeal or file a lawsuit later on.
  • ERISA requires that the insurance company must make an appeal determination within 90 days of receiving the appeal.
  • Some disability benefits plans require two appeals, but ERISA specifically states that plans cannot require a claimant to file more than two appeals before filing a civil lawsuit.
  • After exhausting the appeal process, a claimant may file a civil lawsuit, but due to ERISA, the claimant must file in federal courts.
  • ERISA preempts state laws, which means that disability claims under ERISA cannot include bad faith damages as well as damages for pain and suffering.
  • The federal court’s review will ordinarily be limited to evidence available at the time of the final determination. Limited discovery is allowed in some ERISA claims.

Contact Houston LTD Attorney William Herren Today

Despite the long and complex regulations set forth by ERISA, some of the most important pieces of information include the appeal process as well as the deadline for appeal. With years of experience dealing with long term disability claims and ERISA cases, we at Herren Law have the in-depth legal knowledge and litigation strategies that you need to put forward a strong and comprehensive case. For a free, no-obligation consultation with our Houston-based firm, call long term disability attorney William Herren today at (713) 682-8194.

Filed Under: Long Term Disability Tagged With: , ,
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