Many employers and private insurers offer short and long-term disability insurance policies to provide income to those who have been injured and cannot work while they are recuperating. Unfortunately, long-term disability claims are often denied, which can be devastating for a victim and his or her family, especially if the household is supported by a single income. However, those whose claims have been denied do have legal recourse, either through the Employee Retirement Income Security Act (ERISA) appeals process or the court system. If you live in Chicago and were recently denied long-term disability coverage for an injury, it is crucial to retain an experienced long-term disability attorney who can explain your legal options.
If a long-term disability policy was procured from a private insurer or a government or church employer, the claimant can file a claim for reconsideration in court immediately following the denial without having to go through an appeals process. Depending on the reason for the denial, the claimant may be required to provide additional medical documentation or fix any problems with the original claim application. Unfortunately, many claims are denied not due to the fault of a claimant, but because of the bad faith actions of an insurer or a breach of contract. In these cases, the claimant can sue for additional punitive damages.
Both short and long-term disability claims provided by private employers are regulated by ERISA. This means that those whose claims have been denied must first go through the ERISA-approved appeals process before filing a private lawsuit. These claims must be filed within 180 days of the initial denial to receive reconsideration. The claimant may be asked to submit additional information, including:
If after review, a claim is again denied the claimant can file a lawsuit in court. However, plaintiffs appealing a denied claim cannot seek bad faith or punitive damages in court because ERISA preempts these types of state law claims. As a result, denied claimants can only sue for the benefits they are owed under the terms of their plans.
Even those who plan ahead and invest in long-term disability insurance may have their claims denied when they need help the most. In these cases, claimants can appeal their denied claims and have their cases reviewed. Unfortunately, this can be a difficult and time-consuming process, so if you have been denied benefits under a long-term disability plan, please contact Michael Bartolic, LLP by calling (312) 635-1600 or by completing one of our standard contact forms and we’ll help you schedule a free consultation with an experienced long-term disability attorney.