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ERISA Protects and Complicates Long-Term Disability Insurance

There are numerous ways for someone in California to protect him or herself from financial hardship in the event of a catastrophic illness or injury. When these events require a worker to take a significant amount of time off work, unpaid sick days are usually not enough to support the family during recovery. Some workers are fortunate that their private employers offer long-term disability insurance as part of their benefits package. Under most circumstances, these benefits are governed by ERISA – the Employee Retirement Income Security Act of 1974.

If you have long term disability coverage under an ERISA-governed plan, you would be wise to take steps to gain a thorough understanding of the often-confusing rules ERISA mandates regarding how these types of claims work.

For example, if an employee files a claim for benefits, the insurance provider has a limited amount of time to determine whether it will approve the claim. ERISA also requires that a plan participant whose claim for LTD benefits is denied must receive a written explanation setting forth the specific reasons for the denial. There are also rules which, in most cases, require that the claimant go through an appeals process with the insurance company prior to filing a lawsuit for benefits.

After the denial of an appeal, an employee may file a lawsuit. These cases usually wind up in federal court and are decided by a judge rather than a jury. Live testimony is rarely allowed. Consequently, one of the major factors in winning these cases is whether or not you have provided the insurance company with substantial and adequate documentation of your disability during the appeals phase of your claim.

Because of ERISA’s complicated rules, navigating a long-term disability insurance claim is often tricky from the very beginning. Fortunately, there are attorneys in California who are experienced in dealing with the process – from the initial application, to administrative appeals and through lawsuits. Having such a legal professional as an advocate will usually be a huge benefit for any employee seeking to successfully navigate this complicated area of the law.

Client Reviews
Just when I thought there was no hope to recover my LTD benefits, I found attorney Constantin Roboostoff. With his expertise, I was able to recover all of my back long term disability benefits. Other attorneys wouldn’t take my case because it wasn’t cut and dry. Mr. Roboostoff took the challenge and did an incredible job. Not only did he get my current disability benefits going, he also recovered all my back benefits. He was a true blessing and I would recommend him whole heartedly. CW
It was my pleasure to make contact with Scott Kalkin three years ago after other lawyers had turned me away and told me I would not succeed in my lawsuit. Thanks to Scott's thoroughness, dedication, and diligence, my lawsuit WAS successful and he saw me through to the end, which included putting legal pressure on the insurance company which had invested so much time, personnel, and money, in not paying me what was due. RB
As soon as I met with Scott, I could tell he was knowledgeable, resourceful, experienced, highly professional, and would be dedicated to getting me fair treatment. Scott has handled all interactions with my insurance company ever since. Being able to rely on him to represent me has been a huge relief for a chronically ill person. SO