• How Does an Individual Disability Claim Differ From an ERISA Group Disability Claim?

How does an individual disability claim differ from an ERISA group disability claim?

There are a couple of differences between a private claim and an ERISA claim.

No.1 and probably the biggest problem with ERISA is that you are not entitled to a jury trial when a claim is governed by ERISA. So, which essentially means if you don’t have the right to a jury trial that means that a judge is going to make the decision for you and it gets even more complicated than that. When the judge is asked to make a decision after a person has exhausted all his appeals, the judge has to decide as to whether the insurance company acted in an arbitrary or capricious manner. Basically, the judge is asked if the insurance company acted reasonably. For an insurance company to go ahead and act reasonably, they basically just have to have a person’s medical records reviewed, possibly speak to their doctor, it is a very low threshold for the insurance company which makes it an easy threshold for them to overcome, so that when it gets to the court and the judge is asked if the insurance company acted unreasonably, usually 8 out of 10 times the judge has to find that they acted reasonably even if he thinks that the person is disabled.

The second biggest problem with an ERISA claim is that, there are no penalties against the company. For example, if a person comes and to me who bought a policy on his own and was denied benefits, we could immediately go ahead and file a lawsuit. With the ERISA claim we have to exhaust the administrative remedies and then file a lawsuit. If the company is proved to have wrongfully and intentionally or recklessly denied their benefits, there are extra contractual penalties that can be had against this disability company. With ERISA, there are no penalties against the company. So essentially at the end of the day if you prove that the insurance company was wrong at the end of the day, you get your money and you get a sorry saying “we were wrong” but there are no remedies whatsoever. And that process, going through all the appeals, filing a lawsuit can take several years and at the end of the day the only responsibility an insurance company has is to pay you your benefits, some interest on a judgment and possibly pay your attorney’s fees.

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Do you work in my state?

Yes. We are a national disability insurance law firm that is available to represent you regardless of where you live in the United States. We have partner lawyers in every state and we have filed lawsuits in most federal courts nationwide. Our disability lawyers represent disability claimants at all stages of a claim for disability insurance benefits. There is nothing that our lawyers have not seen in the disability insurance world.

What are your fees?

Since we represent disability insurance claimants at different stages of a disability insurance claim we offer a variety of different fee options. We understand that claimants living on disability insurance benefits have a limited source of income; therefore we always try to work with the claimant to make our attorney fees as affordable as possible.

The three available fee options are a contingency fee agreement (no attorney fee or cost unless we make a recovery), hourly fee or fixed flat rate.

In every case we provide each client with a written fee agreement detailing the terms and conditions. We always offer a free initial phone consultation and we appreciate the opportunity to work with you in obtaining payment of your disability insurance benefits.

Do I have to come to your office to work with your law firm?

No. For purposes of efficiency and to reduce expenses for our clients we have found that 99% of our clients prefer to communicate via telephone, e-mail, fax, GoToMeeting.com sessions, or Skype. If you prefer an initial in-person meeting please let us know. A disability company will never require you to come to their office and similarly we are set up so that we handle your entire claim without the need for you to come to our office.

How can I contact you?

When you call us during normal business hours you will immediately speak with a disability attorney. We can be reached at 800-682-8331 or by email. Lawyer and staff must return all client calls same day. Client emails are usually replied to within the same business day and seem to be the preferred and most efficient method of communication for most clients.

Dell & Schaefer Client Reviews   *****

Rose L.

My husband had paid for private disability insurance from the first year he worked. 30 some years later he filed a claim, it was denied. Together we submitted the claim 3 times, all times denied. We had no income and were rapidly using up any small savings we had. I searched on the internet, specifically looking for success with my husbands disability provider and found this firm. Within 2 months we had disability payments and when, yet again, the company stopped them after a year with no warning, this firm kept going. We could always call or email and get answers. Everything was explained to us and if there were options, we were given them. It has been a long process but we have a settlement and our lives can move forward. We are grateful for the help we were given by this firm and we recommend them highly.

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