BRYANT LEGAL GROUP
Chicago ERISA Benefits Lawyer
If you receive disability benefits through your employer, chances are those benefits are governed by the federal Employee Retirement Income Security Act, commonly known as ERISA.
ERISA law establishes certain requirements that your employer (the plan sponsor) and insurance company must follow. But unfortunately, it also imposes many legal restrictions, obligations, and delays on disability claimants.
The attorneys at Bryant Legal Group are experienced in assisting clients with short-term and long-term disability claims. Short-term disability plans may be structured as payroll practices governed by state law or as ERISA plans. Most private employer long-term disability plans, however, qualify as ERISA plans. We know the nuances of the law and how ERISA rules can impact your ability to obtain the benefits you need. Whether you need help filing a claim or appealing an unfair denial, give us a call.
Contact us today to schedule a consultation.
I can’t thank David and Jennifer enough for going the extra mile to get Guardian to pay my claim, regardless of the fact that my type of claim, although very legitimate, was difficult to gain coverage. They are my heroes for not giving up. I’m very thankful for both of them and their staff.
What Is ERISA and How Does It Impact My Insurance Claims?
ERISA became federal law in 1974 as a reaction to years of mismanagement and financial abuse in employee benefit plans by plan administrators and insurance companies.
Initially, ERISA was meant to protect plan participants and insurance policyholders from the wrongful conduct of those in control of the plan assets. It established conflict-of-interest laws and various fiduciary duties to give those whose plan assets were diminished (say, in employer-sponsored pension plans) the opportunity to litigate against the defendant responsible for the losses.
ERISA has evolved into a comprehensive regulatory framework covering all employer-sponsored benefit plans. Even denial of disability benefits come under the purview of ERISA. In fact, federal ERISA regulations preempt state regulations in many situations, which can substantially change your legal options and strategies.
Does ERISA Apply to My Disability Insurance Plan?
ERISA coverage applies to welfare benefit plans (including disability insurance, health insurance, life insurance, dental, vision, severance benefits, and retirement plans) provided through almost all private employers.
There are two primary exemptions to ERISA coverage. Your employee benefits plans will not be subject to ERISA rules and regulations if:
- Your employer is a qualified religious organization
- Your employer is a public entity, such as a government agency
Individual disability insurance policies or health insurance coverage that you purchased on your own, rather than through your employer, however, are not governed by ERISA.
Quick Pros and Cons of ERISA Coverage
Again, while ERISA law does offer some important protections for policyholders, there are also several drawbacks when compared to non-ERISA plans.
On the plus side:
- ERISA prohibits employers from retaliating against employees who make a benefits claim (or who exercise their rights in challenging or litigating the denial of a claim).
- ERISA requires that plan administrators provide all plan documents to policyholders who request such information.
- ERISA requires the insurance company provide the rationale for why a benefits claim was denied, all documents that were used to make the determination, and the procedure for filing an appeal.
- ERISA imposes various duties on plan fiduciaries such as the plan administrator, and it gives policyholders the right to sue and recover damages for losses related to the violation of fiduciary duty.
However, there are several ways ERISA can make it harder for claimants to get the benefits they deserve:
- ERISA policyholders must exhaust all their administrative appeal options before filing a lawsuit against the insurance company. This is often a complex, frustrating, and time-consuming process.
- The deadline to file an appeal is only 180 days. This isn’t very much time, particularly if you are dealing with a complex medical issue.
- If you do file a lawsuit, depending on the circuit where the matter is filed, the court may be limited to a review of the insurance company’s claim file. You often cannot add new evidence in support of your claim or in response to the insurance company’s evidence that purportedly supports its decision to deny or terminate benefits.
- Damages for bad faith, which may include punitive damages, are not available to policyholders in ERISA-governed benefit claims.
Looking for Personalized Advice From an Insurance Lawyer?
How Our Chicago ERISA Lawyers Can Protect Your Rights
If you are ready to file a disability claim or have been denied benefits under an ERISA policy, Bryant Legal Group can help. When you work with us, an ERISA disability attorney in Chicago will immediately request a complete copy of your benefit plan.
We are very familiar with the complex language used in these types of plans and will thoroughly review documents to determine the rights and benefits you are owed. Our team will also assist you with the filing of your disability claim and take swift action to appeal any unfair or unreasonable decisions associated with your claim.
At Bryant Legal Group, an experienced Chicago ERISA attorney can assist you in several different ways as you navigate the complexities of your ERISA-governed insurance benefits dispute.
Developing a Comprehensive Insurance Claim File
Developing a comprehensive claim file containing all evidence supporting your disability claim is crucial to the success of your ERISA benefits dispute. Relevant evidence might include:
- Medical records
- Expert reports
- Research reports
- Claim-related communication
- Vocational and functional evaluations
- Personal testimony
- Photographic and video evidence
- Letters of support (from your physician and other healthcare providers)
Remember: even if you end up filing a lawsuit, the court will only be able to review evidence that is already in the claim file. As such, you’ll want to make sure your claim file is as complete as possible.
- Related Article: Do You Know the Deadline for Filing Your ERISA Claim?
Identifying and Litigating Related Employment Conflicts
ERISA prohibits retaliation by an employer against their employee for trying to obtain an insurance benefit. For example, if you submit a claim for disability benefits under your ERISA plan, your employer cannot put you on a damaging alternative career track (i.e., an adverse action) to punish you for simply exercising your rights.
The attorneys at Bryant Legal Group have experience identifying employment-related issues that arise from ERISA disputes and assist clients in such circumstances, including ERISA litigation.
Objecting to Untenable Provisions in Your ERISA Plan
If you have been on the receiving end of a denied ERISA disability claim, a Chicago attorney may be worth contacting for further guidance. Skilled attorneys can identify clauses in your insurance policy that are unenforceable based on applicable law, and your lawyer can advocate aggressively on your behalf to secure the rights that were impeded by the insurer.
Going Through the Administrative Appeals Process
ERISA requires that welfare benefits plan participants, including those who are disability benefits plan participants, first exhaust their administrative appeals before they can pursue civil litigation.
Each plan and insurer have their own administrative appeals procedure, but they are usually complicated. While the insurance company is required by law to inform you about the basics of filing an appeal, they are not going to give you any useful advice about how to build a successful case. They have no incentive to do so and, in most instances, the applicable insurance policy puts the responsibility for proving a disability claim on you, the insured.
Working with a Chicago ERISA disability lawyer gives you the best chance of filing a successful appeal. Depending on the strength of the evidence and legal arguments submitted to support the claim, the insurer may choose to award benefits and avoid the messiness of civil litigation.
Handling ERISA Benefits Litigation
If all your administrative appeals are unsuccessful, you have the option of filing a lawsuit and taking your case to federal court. Our attorneys work closely with our clients to evaluate whether is the appropriate way to try to resolve the matter or if pre-litigation negotiation with the insurance company might work.
Throughout the legal process, your ERISA attorney may continue to negotiate with the insurance company to reach a settlement. This approach provides a dual pathway: pursuing judicial remedies while exploring potential negotiated outcomes.
- Related Article: What Does It Mean to Exhaust Your ERISA Administrative Remedies?
Our Settlements and Verdicts
After our client’s disability insurance benefits were improperly terminated, we negotiated a $1.6 million settlement for him.
Our medical practice team recovered $500,000 for a physician group when an insurer failed to properly reimburse them for their services.
We collected $440,000 in unpaid disability insurance benefits for our client and got her LTD benefits reinstated by proving she was disabled from any occupation.
Consult a Skilled Chicago ERISA Long Term Disability Lawyer to Discuss Your Benefits
Here at Bryant Legal Group, P.C., our team of attorneys boasts decades of experience representing the interests of policyholder-clients in disputes with their insurers (and with plan administrators). We handle both ERISA and non-ERISA insurance claims and, as such, are well-equipped to understand the unique challenges of ERISA litigation.
We are committed to results-oriented legal advocacy. Throughout our firm’s history, we have found that the key to securing a successful resolution in an ERISA dispute is in developing a personalized case strategy. We work closely with our clients throughout the dispute process to ensure our goals are aligned and that we have the information needed to effectively navigate such litigation.
We consistently negotiate favorable settlements and secure favorable verdicts (in administrative appeals and at trial) on behalf of our clients. Over the years, we have secured millions of dollars of benefits in a range of insurance disputes including those that involve ERISA-covered benefits plans.
Interested in learning more about your claim and how best to proceed with resolving your ERISA dispute? Call us today at (312) 561-3010 or submit an online form through our website to connect to an experienced Chicago ERISA long term disability lawyer at Bryant Legal Group, P.C. We look forward to working with you.
The content provided here is for informational purposes only and should not be construed as legal advice on any subject.
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