Experienced ERISA Attorneys Serving Clients in all of California
The Employee Retirement Income Security Act of 1974, or ERISA for short, governs a majority of employer-sponsored group short- and long-term disability policies. If you need to file a disability claim and your employer provided group disability coverage for you as a benefit, this complex piece of federal legislation will likely set out the rules for that claim and any subsequent appeal or litigation.
If you’re a California resident who’s involved in a group disability insurance claim or an administrative appeal, ERISA might sound like it will work in your favor. Unfortunately, the legislation often makes life much more difficult for claimants, playing right into the hands of group disability insurance carriers.
If you’re looking for disability ERISA attorneys in California, you need someone who understands the difficulties the legislation poses. You should also try to find a seasoned ERISA disability lawyer who can counteract the dirty tricks your insurance company may try to pull off to delay or reject your claim. At DarrasLaw, we know exactly what we’re doing and how to win when it comes to California ERISA cases.
What’s Different About an ERISA Claim?
If you purchased a short- or long-term disability insurance policy yourself, without assistance from the company you work for, ERISA may not apply to you or the coverage you bought. The legislation only deals with employer-sponsored group insurance plans. Speak with our California long-term disability attorneys for more assistance.
Appealing a denied claim under an individually purchased plan is relatively simple. You can generally just file a lawsuit against your insurance provider in state or federal court and let a judge and jury decide on the merits of your case. When it comes to employer-sponsored group policies, though, ERISA sets out very strict and unforgiving process by which you must challenge a rejection, and it restricts you in a number of ways.
You are not entitled to a jury trial in ERISA cases so you cannot call witnesses to testify on your behalf or cross-examine opposition witnesses. Additionally, once the administrative appeal is concluded and decided, you cannot introduce any records or reports in any later court proceeding that you did not include in your initial administrative record.
ERISA is a highly complex piece of legislation that changes continually. The US Court of Appeals for the Ninth Circuit and California’s federal District Courts have issued a number of rulings that have shaped the way this federal law affects claimants and insurance carriers. Part of what makes us a top-class California ERISA lawyer is our commitment to staying informed about all these consequential federal changes.
Your Administrative Appeal & Administrative Record
Once your group ERISA disability case ends up before a federal judge, the only evidence considered by the federal court will be the contents of your administrative record. This is the collection of medical records, doctor’s reports, and other relevant material that you and the insurance company put into the administrative appeal.
Remember, your insurance company will be very comprehensive in their denial and appeal and include any records or reports that work in their favor. You can assume that every document you’ve provided to your insurance carrier will end up in your record if it works against you.
Top ERISA Lawyers Helping You in Calfornia
When it comes to items of evidence that benefit you, you’ll need to be careful to ensure they end up in the administrative record as well. Your attorney will be able to identify the most important records, reports, and medical, financial, and occupational documentation necessary for your case.
You should note that ERISA judges assume no knowledge of your working life or the functional limitations your disability has imposed on it. It’s your legal team’s job to persuade the court of your eligibility for benefits using the available evidence, which means the compilation of a comprehensive administrative record is crucial.
Your Benefit Entitlements Under a California ERISA Disability Policy
A broad range of conditions qualify as disabilities for the purposes of short- and long-term disability insurance. Policies define disability in terms of a policyholder’s ability to continue engaging in full- or part-time work following the onset of a sickness or accident, but there are different definitions of disability in different policies issued.
Most employer-sponsored disability insurance policies use an “any occupation” definition of disability. This means claimants are regarded as disabled once their condition prevents them from doing any occupation for which they are trained, educated, or suited. More generous “own occupation” policies treat claimants as disabled once they can no longer carry out the duties associated with the occupation they had prior to the onset of their claim.
Once your physician has confirmed that your condition qualifies as a disability under the terms of your policy and treated you appropriately for the condition, you should become entitled to income replacement benefits once the elimination or waiting period on your policy has elapsed.
In all cases, you should research a policy carefully to gain an understanding of what kind of coverage you have. If you’re struggling with more technical language in your policy or disability certificate, an attorney can be of help.
What Can a California ERISA Lawyer Do for Me?
Group disability insurance carriers thrive on delayed and denied claims; keeping money out of the pockets of deserving claimants is part of how they conduct business. Unfortunately, ERISA rules and stringent regulations sometimes make it easier for carriers to do this in relation to claims on employer- sponsored group disability policies.
That means the assistance of a great disability lawyer is crucial for anyone who’s struggling with this process. If you’re looking for the best California ERISA lawyer, short- or long-term disability insurance policy today to schedule a free initial policy or claim analysis. Filing a prompt, comprehensive, and thorough ERISA appeal is vital to success if you’ve met with an initial denial, so don’t wait around to start the process.