Filing a Lawsuit
If your appeal is denied, your only remaining legal option may be to file a lawsuit in a court of law to recover payment of your disability benefits.
If your short term disability or long term disability policy was part of your employer’s group benefit plan you will most often need to file a lawsuit in federal court. If so, your policy is, with few exceptions, governed by federal law. This law is called the Employee Retirement and Income Security Act of 1974 (ERISA). Discovery is limited with most information being considered by the Judge being the administrative record that was considered by the insurance company prior to its last denial. An experience long term disability lawyer can help you negotiate a lump sum settlement of your claim, or prove that the insurance company’s decision was not only wrong but also unreasonable.
If your policy was an individual policy purchased by you and covering only you, your claim is likely governed by state law. However, there are limited circumstances where state and church employees covered under a group insurance plan are exempt from governance by federal law, ERISA. In these cases, your legal options can be more robust with regard to when you can file a legal action or the types of claims that can be brought. Individual policies can open up the insurance company up to bad faith claims where denials are contrary to the medical evidence and clearly biased by the company’s financial conflict of interest.
Clearly, you will require a lawyer once your only option is to file a lawsuit in a court of law to recover your short term disability or long term disability benefits. It is very important to retain or hire an experienced disability lawyer who focuses his or her practice on this area of law. The more experience on your side, the better your outcome will be. Our legal consultations are free.