Employee Retirement Income Security Act (ERISA) disability litigation is a multi-stage process governed by strict federal laws. Litigation typically begins only after you have exhausted all potential administrative remedies by losing an internal appeal with your insurance provider. Hiring a Tampa ERISA disability litigation lawyer is essential because the law tends to favor insurance companies and offer limited remedies for claimants.
By presenting a strong, complete administrative record, our legal team could advocate for your ERISA benefits when a federal judge reviews your case. Judges typically only consider the documentary evidence in the finalized file, so you need an ERISA attorney from Feldman Legal Group to work on your behalf from the earliest stages of the disability claims process. We could ensure your administrative file is complete with all relevant medical records, vocational reports, and physician statements.
What Are Common Reasons for ERISA Claim Denials?
ERISA provides for a broad range of employer-sponsored welfare benefit plans in the private sector, including disability payments for non-work-related illnesses and injuries. ERISA governs most private employer-sponsored long-term disability plans, setting standards for claims, appeals, and participant rights. These plans typically pay around 60% of your former salary and can last until retirement age (normally 65). ERISA may also cover short-term disability benefits. These plans usually pay about 80% of your salary for several months.
ERISA disability claim denials often arise from specific tactics insurance companies use to minimize their liability. The following reasons for denial frequently form the basis for administrative appeals and subsequent federal litigation.
Lack of Objective Findings
Insurers often deny claims by citing the absence of objective medical evidence (for example, MRIs, CT scans, or blood tests) to support subjective symptoms such as chronic pain, fatigue, or cognitive impairment.
Missing Documentation
Insurers frequently reject claims due to incomplete submissions, missing physician statements on functional limitations, or a lack of a continuous treatment history.
Definition of Occupation:
Many policies transition from an own occupation definition (the inability to do your current job) to any occupation (the inability to do any job that matches your qualifications) after 24 months, and insurers often deny benefits during this transition by identifying sedentary jobs they claim you can perform
Definition of Disability
If your condition does not meet the specific criteria defined in your Summary Plan Description, the insurer can deny the claim even if your doctor classifies you as disabled.
Independent Medical Exams
The insurer may rely on a one-time paper review or a brief examination by their own doctor to override the opinion of your regular treating physician
Look-Back Periods
Most ERISA plans have a clause excluding benefits if you received treatment for the same condition within a specific period (usually three to 12 months) before your coverage began, so insurers often aggressively link current symptoms to past medical history to trigger this exclusion
Our Tampa lawyers could assist with your ERISA disability benefits claim and any subsequent appeals or legal proceedings.
What to Know About ERISA Deadlines
ERISA has strict, non-negotiable deadlines for filing initial claims and appeals. Missing a deadline by even one day can result in an automatic denial and loss of your right to sue. Minor clerical errors, such as missing signatures or incorrect personal data, can also be grounds for rejection.
Many ERISA plans limit benefits for mental health conditions to just 24 months, whereas they may cover physical disabilities until retirement age. Insurers may attempt to reclassify a physical disability as psychiatric to limit the payout. Our skilled attorneys in Tampa could help you ensure no deadlines are missed and all paperwork is filed properly.
How Does ERISA Disability Litigation Work?
ERISA disability litigation is a unique federal process that differs significantly from standard civil lawsuits. Only if the insurer denies your administrative appeal can you file a lawsuit in federal district court to recover your benefits. The judge can generally only review the administrative record: the exact documents, medical files, and correspondence against which the insurance company made its final denial. In these cases, it is also important to be aware of the following:
Discretionary Clauses
Most policies contain discretionary clauses that give the insurer broad power to interpret the policy. Under this standard, the judge must uphold the denial as long as it was reasonable, even if they personally support your claim of disability. If the policy does not have a discretionary clause, the judge reviews the file independently and makes their own determination.
Lack of a Jury
There are no jury trials in ERISA cases; a single federal judge decides the case. If you win, the court typically orders the payment of back benefits, interest, and potentially your lawyer’s fees and court costs. Some cases settle for a buy-out, where the insurance company pays a lump sum in exchange for you giving up all future rights to the claim.
Discovery Period
Discovery in ERISA cases is severely limited, so interviewing witnesses is rarely an option. Discovery is usually restricted to investigating potential conflicts of interest, such as whether the insurer’s doctors were financially biased. Most federal courts require the parties to participate in mediation before a judge makes a final ruling.
No Option to Testify
You and your doctors typically cannot testify in court. In a lawsuit, the judge makes their decision based on written legal arguments about your disability and eligibility for federal employee benefits submitted by our Tampa legal team, along with the insurer’s attorney’s rebuttal. It is important to consult a lawyer to protect your right to secure potential benefits and maximize your chances of success in court.
Call a Tampa Attorney Today About an ERISA Disability Lawsuit
ERISA law is complex, and discretionary insurance clauses make it challenging to handle a claim on your own. A Tampa ERISA disability litigation lawyer could manage the process and increase your chances of achieving a successful outcome if litigation becomes necessary. Mitchell Feldman’s experienced legal team knows how to identify specific evidence that demonstrates abuse of discretion. Contact Feldman Legal Group today to discuss your legal options in a one-on-one, free consultation.
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