Sue Your Disability Insurance Company

The federal court is a battleground and we love representing the “little guy” against the multi-billion dollar insurance company giants. Our disability lawyers have filed ERISA long term disability insurance lawsuits against every major disability insurance company in federal court nationwide. We have helped our clients to recover hundreds of millions of dollars in long term disability benefits. We have seen every disability company argument and we know exactly how to respond in order to give our clients the best chance to win benefits. We never charge our clients any attorney fees or costs unless we are able to make a recovery.

The legal battle to win long term disability benefits is fierce. ERISA is a pro-insurance company federal law and a claimant filing an ERISA lawsuit is surprised to learn they may not get the fair trial they have always expected when taking a case to court.

We have prepared some videos which will educate you about what to expect and our experience with ERISA disability lawsuits.

The Unfair Discretionary Clause

The experience and skill of an ERISA disability lawyer is extremely important because claimants do not start on a level playing field when filing an ERISA disability lawsuit. A review of ERISA legal decisions issued by federal judges in the past ten years reveals that more than 70% of ERISA long term disability lawsuits are won by insurance companies as result of the unfair “discretionary clauses” found in most group disability insurance policies. The quality of the claim review performed by the disability company and the strength of the disability evidence presented by a claimant are the key factors in determining if a claimant can prevail in an ERISA disability lawsuit.

If a claimant submitted a weak ERISA appeal, then the chance of success after filing a lawsuit will be low. Our disability attorneys review thousands of long term disability denials each year and we only accept a case if we think we can make a recovery for the client. Despite the challenge of these cases, our disability attorneys have been able to reach a resolution satisfactory to our clients in more than 98% of the ERISA lawsuits we have filed nationwide. Favorable resolutions range from payment of all past due disability benefits with reinstatement of future benefits to a one–time lump sum settlement payment.

Why Are ERISA Disability Lawsuits Challenging?

ERISA DISABILITY CHALLENGES:

1. No Right To Jury Trial
2. No Live Testimony
3. No New Evidence Permitted
4. Court Must Defer to Company
5. No Punitive Damages
6. Can Only Recover Benefits Owed
7. Standard of Review is Pro-Insurance
8. No Guaranteed Attorney Fees

The high level of court verdicts in favor of disability insurance companies is because the “discretionary clause” in a disability policy creates a standard of review that only allows a judge to reverse a claim denial if the judge finds that the insurance company acted unreasonably in reaching their claim decision. It is an unreasonably low threshold that a disability insurance company must satisfy in order to have their claim decision upheld. Through our experience of handling thousands of ERISA lawsuits we know every possible angle to argue for our clients and we have earned a strong reputation for being skillful and strong advocates for our clients. We constantly monitor the case law in every federal court nationwide and our clients benefit from our experience in litigating ERISA lawsuits against every major disability insurance company on a daily basis.

Standard Of Review

One of the most challenging aspects in an ERISA disability lawsuit is the standard of review that a federal court will apply when reviewing a long term disability denial. The most favorable standard of review for a claimant is a de-novo review. In every long term disability lawsuit we always look for the best argument for a court to apply a de-novo review. A de-novo review essentially means that the judge will conduct an independent review of the entire administrative record and make a determination as to whether the claimant is entitled to disability benefits. The least favorable standard is the abuse of discretion standard which means that the judge can only reverse the insurance company’s denial of benefits if the judge believes that the denial of benefits was wrong and the insurance company acted arbitrary and capricious. Essentially, the judge must find that the insurance company acted unreasonably in order to reverse a disability denial. The judge will determine which standard of review to apply depending on whether or not the subject long term disability policy contains a “discretionary clause” that grants discretion to the insurance company to interpret the terms of the disability policy and determine eligibility for benefits. In every case we look for an argument to prove that the discretionary clause is invalid and a de-novo review must be applied. There are approximately 13 states that have made discretionary clauses illegal.

No New Evidence Or Testimony

The inability to present any new evidence or testimony after filing an ERISA lawsuit is a huge disadvantage. The judge deciding the case never has the opportunity to make a face to face determination of the validity of the claimant’s disabling complaints. It’s like hiring a person for a job without interviewing them in person. Further, a judge reviews a case usually 18 months after a claim has been denied, and the judge has no idea about the current medical condition of the claimants. The claimant’s lawyer is not allowed to take a deposition or cross exam in court the individual at the insurance company that made the decision to deny the claim. A judge is required to review all of the motions filed by the lawyers and can only review the same information that was available for the insurance company up until a final claim decision was made.

Our clients have a significant advantage when we prepare the ERISA appeal as we submit every single piece of information that we would want a judge to review in the event of claim denial. We accept cases where we have not prepared the appeal, but we are married to the evidence that is already contained in the administrative record. We can still achieve a good outcome for the client as we can usually prove that the disability company denial was unreasonable for many reasons.

No Right To Jury Trial

Our lawyers like jury trials and think that in the majority of claims a jury trial would greatly benefit a claimant. Unfortunately, an ERISA disability claimant has no legal right to a jury trial since ERISA lawsuits are equity actions rather than common law actions. We would bore you with the details behind this as it’s a topic that law students discuss for at least a week in law school. A few advantages to a non-jury trial are a trial date can be achieved sooner, the Judge’s past rulings in other ERISA lawsuits are a good predictor of the outcome in a pending suit, it costs a lot less money to bring the case to trial, neither side has the ability to enter new evidence and you receive a written opinion from the court that could be appealed.

Remedies In ERISA Disability Lawsuits

The remedies available when filing an ERISA lawsuit are not exactly what most claimants expect them to be. When an ERISA lawsuit is filed a claimant is required to argue that the insurance company breached their fiduciary duty and as such must pay benefits owed to the claimant. The court can only award past due benefits and cannot make the insurance company award future benefits in most cases. An unfortunate outcome in approximately 50% of ERISA lawsuits is that the court “remands” the case back to the insurance company and gives them another chance to review the claim pursuant to the court’s findings. In many cases this will result in a reversal of a claim denial, but it gives the insurance company an unfair second chance to review the file. The claimant is stuck waiting several more months for the insurance company to review the claim for what it is now a third or fourth review.

Many people suffer economic losses as a result of the disability denial, but ERISA law does not allow any compensation for any other damages other than the benefits owed. This means that an insurance company is not responsible for any debt, foreclosures, credit score reduction, loss of car, or homelessness that can happen as a result of a wrongful disability denial. Furthermore, no matter how horrible or unreasonable the claim denial was a claimant has no right to receive any punitive or bad faith damages. The inability to seek extra contractual or punitive damages is the primary reason that insurance companies do not have big concerns about the financial impact of a claimant winning a disability lawsuit. The award of attorney fees in ERISA lawsuits is at the discretion of the judge. The judge can award attorney fees if he or she determines that the claimant had “some success on merits of the case”. Attorney fees are litigated extensively after the court makes a finding in favor of the claimant. In most cases a claimant will receive interest on the past due benefits that have not been paid. In most claimant victories the insurance company will appeal the decision to the Court of Appeals, yet the attorney fees and interest owed will continue to accrue.

Time to File Lawsuit Is Critical

Most claimants we speak to want to immediately sue their disability company upon receiving a denial, but the horrific ERISA law does not allow an ERISA disability lawsuit to be filed until the required number of ERISA appeals have been reviewed by your disability insurance company. Failure to file an ERISA lawsuit at the appropriate time can result in the entire claim being dismissed.

We File ERISA Disability Lawsuits Nationwide

ERISA disability lawsuits can only be filed in Federal Court and often we have a few options in selecting the state in which we want to file the lawsuit. While many lawyers do not like to practice in federal court due to the strict deadlines and intensive written motion requirements, we prefer federal court and believe that claimants receive a high level judicial review from a federal judge versus a judge in state court.