ERISA

Do you need to file a claim for disability benefits under your employer’s insurance policy? Has your claim been denied or have your disability benefits been terminated?

If you are seeking long-term disability benefits, you need a strong attorney who will fight aggressively by your side to ensure you obtain the benefits you are entitled to.  Houston employment lawyers Robert J. Wiley, and Kalandra N. Wheeler fight for workers whose long-term disability insurance benefits have either been terminated or denied all together.

The Employee Retirement Income Security Act of 1974 (ERISA) is a federal law that governs standards for most voluntarily established pension and health plans within private companies. ERISA was enacted to protect employees in these plans by setting minimum standards of participation, vesting, benefit accrual, and funding. ERISA also requires employers to establish a grievance and appeals process for employees enrolled in these plans. Should an employee’s defined benefit plan be terminated, ERISA guarantees payment of certain benefits through the Pension Benefit Guaranty Corporation (PBGC), which is a federally chartered corporation.

Generally, ERISA does not cover retirement plans established or maintained by governmental entities, churches for their employees, and plans which are maintained in compliance with workers compensation, unemployment or disability laws. Also, ERISA does not cover plans outside the United States set primarily nonresident aliens or unfunded excess benefit plans.

There are two types of disability benefit plans. Short-term disability insurance is typically paid by the individual employees; long-term disability insurance is generally covered by the employers and begins once an employee’s short-term disability benefits end. Long-term disability insurance provides employees with disabilities a percentage of their income for an broad period of time.

However, an insurance program sponsored by your employer can deny you benefits by asserting that your condition does not qualify as a disability under its policy. This can be completely devastating for an applicant.  If your claim is denied, it is imperative that you seek legal consultation immediately! Though the initial claim process is generally straightforward, under no circumstances should an applicant handle the appeal for disability benefits without an experienced licensed attorney.

An appeal much be submitted in writing and in a timely manner. An appeal is an applicant’s last opportunity to provide the court with substantial documentation and information regarding their claim.  Unfortunately, most internal appeals are denied, which is when the applicant may file suit. Because the administrative record is the only evidence permitted for an applicant to present in court once suit if filed, it is crucial to submit all relevant and vital paperwork in the internal appeal. Without sufficient documentation, the judge may be forced to affirm the plan manager or the insurer’s denial.

ERISA has strict requirements and guidelines that can doom an employee’s claim for disability benefits. More importantly, if an employee misses a particular deadline or claim requirement, he or she may not even be able to file an appeal. That is why it is absolutely important to consult with attorney to aid you through the ERISA claim process.

If you are considering filing a disability claim, contact us our office without delay. Our attorneys begin by scheduling an initial consultation at our office.  At the time, one of our licensed and experienced attorneys will discuss and evaluate your claim, as well as outline the steps in the ERISA claim process.

ERISA requirements and provisions are complex and its stringent guidelines can easily make it impossible for an employee to file a claim. That is why you will need an attorney with the talent and experience.  Contact our office and present your case to ensure you receive the benefits you deserve.