On Your Side

Dealing with Disability Claims (not Social Security)

Whether your disability claim involves an insurance company or ERISA Plan, you can anticipate that you will have to fight hard to get the benefits you seek. Whether you are entitled to disability benefits will often turn on how “disability” is defined in a policy or Plan and whether ERISA or private insurance is involved. Determinations under ERISA enjoy a wide degree of discretion – in other words one human being decides in his/her discretion whether you are entitled to benefits. The decisionmaker often has wide latitude or discretion to decide on your claim. In contrast, disability from a private insurance policy not governed by ERISA is controlled by state insurance laws – not an abuse of discretion standard but what the policy says and ultimately what a jury decides. Whether self-insured or funded by insurance, a claim for benefits under a disability policy may be denied in an effort to lower costs or increase profits, or as a part of a business model.

If your ERISA based claim is denied, you can appeal, first to the plan administrator, and then file a lawsuit. An ERISA plan typically has language about the appeals process and how an appeal should be handled. Again, this is a complex process, requiring detailed attention to documentation requested by the plan administrator and what might be offered to support your disability claim. At The Law Office of Mark A. Ticer, our Dallas disability claim lawyer has many years of experience helping people obtain disability benefits, including pursuing ERISA based administrative appeals.

Appealing a Denied Claim? We Can Help

Among other things, our task is make sure that the material submitted with an ERISA controlled disability appeal is thorough and includes all critical, relevant, and necessary information. It is critical to have a complete record at this stage of the process, as it may be difficult to add new documentation if your appeal is denied, leaving the only remaining option of a lawsuit.

In addition to obtaining complete medical records from every treating physician, we have created video presentations featuring doctors and other professionals who discuss a client’s disability and the evidence and medical proof to back it up. Doctor videos can be very compelling and persuasive, and are just one way of enhancing the success of your claim.

Contact our Dallas law firm to learn more about appealing a denied ERISA-covered claim.