Long-term disability insurance offers a sense of security, and the knowledge that you’ve protected your family’s financial security if you become unable to work due to illness or injury. You should be able to count on that, but insurance companies don’t always play fair. When your disability insurance benefits are denied, it can be jarring, and you may be uncertain where to turn for help. 

If the disability insurance is provided by your employer, your claim will probably be governed by a federal law called the Employee Retirement Income Security Act of 1974 (ERISA). ERISA creates certain obligations for plan administrators, including: 

  • How you must be provided with information about filing a claim
  • A time limit for making a determination on the claim (typically 45 days, but that may be extended in certain circumstances)
  • What information must be provided to you if your claim is denied
  • An opportunity to appeal, with at least 180 days to do so
  • A requirement that someone different review your claim on appeal, and ignore the original determination
  • A deadline for a determination on the appeal (typically 45 days, but may be extended in certain circumstances)

In most cases, the disability applicant must complete this process before filing a lawsuit under the ERISA statute to collect benefits.  However, sometimes when the ERISA administrator isn’t following the correct procedures for ERISA claims, it is possible to pursue your claim in court sooner. The best source of information about the procedures and your options is a disability insurance attorney that is highly experienced and knowledgeable about ERISA disability insurance litigation.

Cremeens Law Group PLLC Fights for Your Disability Benefits

The ERISA disability lawyer at Cremeens Law Group PLLC has extensive experience with ERISA disability cases in Tampa and throughout the state of Florida. Disability appeals and litigation are all we do, so we thoroughly understand both the legal issues you face and how stressful and confusing the process can be.  We never forget that every client is a unique individual in a difficult situation. We will put the full force of our knowledge and experience to work for you, and we’ll work to ensure that you have the information you need to feel confident and in control of your claim. 

The best way to find the right ERISA attorney for you is to talk to the lawyer, ask questions, and ensure that you are comfortable interacting with them and trust in their knowledge and experience. We offer free consultations to help you make the best decision for you and your family. You can schedule yours right now by calling 813-839-2000 (813-839-2000) or filling out our contact form.

If you live anywhere within the state of Florida and have a denial letter from a disability insurance company, please give us a call to see if we can help you. 

What to Expect from an ERISA Disability Appeal

Disability claims may be denied for a variety of reasons. For example, the carrier may determine that you aren’t disabled because they didn’t receive sufficient medical documentation, or because the insurer’s  independent examiner comes to a different conclusion. Or, the insurer may argue that your disability is caused in whole or part due to a pre-existing condition. The best approach to appealing your denial will depend on the reason for your denial. 

If you sign with us after your initial denial, we’ll review your plan documents, your denial letter, your medical records and other information. Then, we’ll work with you to gather any other evidence that will be helpful in appealing your claim. In some cases, this will include further medical evaluation. Since the appeal must generally be filed within 180 days, you should contact us as soon as possible after receiving your denial letter. 

Often, a well-constructed appeal is all that’s required to secure your disability benefits. Many people miss out on this opportunity because they don’t understand what type of additional information is required to change the result, or how to present it most effectively. An experienced ERISA disability attorney who knows the answers to those questions can be your best resource.  Remember, the general rule is that all evidence for an ERISA case closes after the insurer provides a final decision on appeal.  This is why calling the ERISA disability insurance attorney while you still have the right to appeal is generally better than calling after your appeal is denied.  

ERISA Disability Litigation

If the appeal is unsuccessful, or if the administrator and/or insurance carrier are not complying with the procedures and timelines mandated by the regulations governing ERISA, the next step is a lawsuit for disability insurance benefits pursuant to the ERISA statute.  An ERISA disability lawsuit is more complicated than an appeal, and requires extensive knowledge of both substantive law and procedural requirements. If your appeal has been denied, you should contact an ERISA attorney right away.

FAQs About ERISA Disability Claims

There’s no substitute for personalized advice from a qualified attorney. The general information below will give you an idea of what to expect, and may be helpful in planning your next steps.

For most individuals who receive their insurance as an employee benefit, a federal statute known as ERISA, the Employee Retirement Income Security Act of 1974, controls the administration of their benefits. This federal law can be complex and sets out certain procedures and timelines that must be followed in order to successfully appeal a claim denial. The ERISA statute controls your remedies if it governs your case, so that a judge rather than a jury would hear your case, and affects admissible evidence in some cases so that the judge generally reviews the administrative record compiled by the administrator rather than taking evidence from witnesses. Finding out that your ERISA claim has been denied can be incredibly stressful and navigating the complex appeals process may seem daunting. At Cremeens Law Group PLLC, we want to help you get the benefits you need. We have been serving Florida residents since 2003, working only in the area of disability insurance appeals and litigation.
A Tampa ERISA lawyer can help assess the reason for your denial, review your original claim, put together stronger evidence for your appeal, and present that information in the most effective manner. If your appeal has been denied, an ERISA attorney can review your file, explain its strengths and weaknesses, file a lawsuit on your behalf, negotiate with the insurance company, try your case in the District Court for your jurisdiction, and offer an appeal to the Appellate Court for your jurisdiction.
The best way to successfully appeal an ERISA claim denial is to work with a law firm that is familiar with how ERISA administration works, and that has experience with the appeals process. At Cremeens Law Group PLLC, we want to help you build a strong case to reverse the decision that left you without insurance coverage. Given the strict deadlines for ERISA appeals, we encourage individuals to call us soon after receiving their denial, so we have the necessary time to help clients pull together the documentation they need to succeed in the appeals process. Being unsuccessful in your initial appeal does not mean that you will never get disability insurance coverage. Appealing an insurance claim that has been denied can seem overwhelming. Working with a law firm that understands the processes, deadlines, and criteria can significantly raise your chances for success. Our firm has successfully appealed cases to the federal courts. We understand what it takes to be successful in these appeals. We can represent you through the initial long-term disability application, appeal and/or any necessary litigation so that you have consistent, thorough representation by a firm committed to doing whatever we can to get you the benefits you need.
Cremeens Law Group PLLC focuses primarily on ERISA long-term disability insurance appeals and litigation. We also handle ERISA short-term disability matters. Though ERISA claims are our focus, we also occasionally handle non-ERISA short-term and long-term disability matters.
One of the first steps is to take a look at where you work. Most government jobs will fall under a non-ERISA claim. Also common to non-ERISA claims are people who work for a church or religious organization or a hospital. Non-ERISA plans are governed by state law. State law can often be more favorable for many cases. If you have received a denial letter from a disability insurance company, and your case falls under the ERISA statute, there should be language in there that specifies rights that you have under ERISA. Check your denial letter for ERISA language. Whether you have an ERISA long-term disability claim or state law claim that has been denied, we are experienced in handling disability appeals and insurance litigation cases that fall under both federal ERISA law and state insurance laws. Our firm has successfully concluded thousands of disability insurance cases. That experience means we bring a wealth of knowledge about the system to each client’s case.