Our Disability Lawyers Will Guide You Through ERISA Claims and Appeals
When a person is injured at work and files for ERISA benefits like short- or long-term disability, or long-term care, there is a specific way to proceed to avoid being denied coverage or having failed appeals.
Do You Need to Talk to an ERISA or Disability Attorney?
You need to have a skilled ERISA attorney or disability lawyer working on your behalf to go through each step of the process so that you have your best chance of getting the benefits you need.
What is ERISA?
According to the U.S. Department of Labor, the Employment Retirement Income Security Act of 1974, or ERISA, is a federal law that sets minimum standards for most voluntarily established retirement and health plans in private industry to provide protection for individuals in these plans.
It’s a very complex law that helps determine whether or not your insurance provider should pay for your disability claim. There are many specific deadlines, dates and details – and only ERISA lawyers know how to review and file ERISA claims and appeals properly. Filing with mistakes or at the wrong time can be the difference between getting the funds you need and being denied.
When Do You Need an ERISA or Disability Attorney?
ERISA governs employee benefits, including health insurance, pensions, disability benefits, and life insurance. If you have a dispute with your insurer about one of these issues, then ERISA is likely the law that applies to that dispute. But ERISA is difficult to understand. Our experienced ERISA lawyers can meet with you and discuss your legal options and next steps.
We help people:
Short-Term Disability
Your employer-provided short-term disability benefits protect you when you become injured, sick, or disabled, and can’t work. If you’re permanently disabled, you may be eligible for long-term disability benefits, but the first step in the process is to obtain short-term disability.
After you’re approved for short-term disability benefits, you can apply for long-term benefits. That’s why short-term disability insurance benefits are important to your current and long-term financial health.
Insurers deny claims if they feel there isn’t enough medical proof of your disability. Being legitimately disabled with a doctor’s acknowledgement isn’t always enough. A Keches Law disability attorney can help you make the best case for yourself.
Long-Term Disability
If you become disabled, long-term disability benefits are vital to your well-being, both financially and physically. But it can be a lengthy process.
The process gets even trickier if your initial claim is rejected. Under ERISA, before litigation, you are required to appeal to the insurance company if your claim is rejected or terminated. But information you provide during this appeal is the only information you are legally allowed to use to make your case. When the insurance company reaches a final decision, you can’t introduce additional or new evidence.
This is a problem that won’t come up if you have the right people on your side. Let one of our experienced long-term disability insurance benefits lawyers guide you through the appeals process so all relevant information is included with your appeal.
Long-Term Care
Few families can afford the costs of a nursing home, in-home nurse, or other long-term care arrangements. Yet ordinary health insurance does not cover long-term care.
Once the person who needs care has all but exhausted their money and assets, some federal and state benefits, such as Medicaid, will cover nursing home care and assisted living. But aside from that situation, and because of the high cost of such care, insurance companies take a very close look at claims for long-term care insurance.
Insurance companies will deny a claim when they can argue there is an exclusion that bars coverage or premiums were not paid on time. Extensive documentation is required demonstrating that the beneficiary of the insurance policy truly meets the terms.
With significant experience helping clients apply for long-term care benefits, we can assist your loved ones with applying for and maintaining their eligibility for benefits by working with their doctors and professionals to help show your continued eligibility for benefits under their policies.
Disability for Massachusetts State Employees
Ordinary Disability Retirement
Ordinary disability retirement provides benefits for injured or sick state employees who have worked full-time for the state for the equivalent of 10 years if they can no longer perform their job duties.
It can take a year or more to receive ODR benefits. A three-member panel analyzes your disability claim, including the cause of your disability and the reasons why you can’t continue working. Making sure the claim is submitted properly is very important. The panel checks for mistakes in the paperwork and analyzes the evidence before deciding whether to approve your application.
Accidental Disability Retirement
If you’re a state employee and became disabled on the job, you may qualify for accidental disability retirement benefits. If you can show the state board of retirement and the public employee retirement administration commission that you are not capable of working, these benefits pay you a portion of your salary.
Accidental disability retirement benefits may be available in addition to your workers’ compensation claim. If successful, you will receive 72% of your preinjury salary or wages. Even if you haven’t worked for the state for very long, there isn’t a minimum time of employment to receive benefits, and the benefits may last the rest of your life.
Life Insurance
When you lose a loved one, finances usually aren’t top of mind. But the financial ramifications of losing a loved one can be dramatic and long-term. Life insurance can help offset some of the costs associated with such a tragedy, but only if your life insurance company approves the benefits.
Many life insurance policies have significant exclusions, meaning your family may not be covered under certain circumstances. Your insurance company may allege fraud, meaning that you or your loved one made a material omission about underlying health or health behaviors, which would allow them to deny your claim. Finally, the insurance company may allege you failed to pay premiums, which would also allow them to refuse to pay you benefits.
Other Insurance Benefits
Employer-provided benefits come with any number of exclusions and caveats. If you have been denied such a benefit, you may not even know where to start in appealing your claim. Contact a Keches Law Insurance Benefits Lawyer for any of these reasons.
Health Insurance
Your insurer may allege fraud or reference an exclusion when denying your health insurance benefit. Our experienced lawyers can review your claim and policy language to protect your rights and interests during this difficult time.
Accidental Death and Dismemberment Insurance
AD&D insurance contains numerous exclusions, including death caused by suicide and “natural causes.” We hold insurance companies accountable to the policy and will enforce your rights.
Premium Waiver Disputes
When you become disabled, some insurance companies will waive your responsibility to continue paying life insurance premiums so long as you meet certain criteria pursuant to the terms of your policy.
Retirement and Pension Benefits
We rely on our retirement savings a great deal. Getting the pension or retirement benefits you deserve can be complicated. We can help.
Severance Claims
We can help you resolve disputes over your severance package.
Contact an ERISA Lawyer at Keches Law Group
If you need help, contact us today. A talented and capable Keches Law Employee Benefits Attorney is waiting to hear your story, and our firm has the resources to investigate your claim.
Keches Law Group is one of the largest and most well-respected personal injury and workers’ compensation law firms in Massachusetts. Since opening in 1986, we’ve recovered more than $2 billion for our clients. Other practice areas include social security disability, employment law, class action, medical malpractice, and more.
