Indiana Disability Lawyers
At Dabdoub Law Firm, we understand the complexities and frustrations individuals face when trying to obtain ERISA and long-term disability benefits. Our team of experienced attorneys is dedicated to guiding you through the intricate legal landscape, ensuring that your rights are protected and that you receive the benefits you deserve.
Our disability insurance attorneys have experience with ERISA and long-term disability claims across the country, including with clients in Indiana. Trust us to fight for your rights and secure the financial assistance you need during challenging times.
To secure the services of our firm, contact our Indiana disability attorney for a free initial consultation at (800) 969-0488.
What is ERISA?
ERISA, which stands for the Employee Retirement Income Security Act, is a federal law enacted in 1974 to protect the rights of employees who participate in employer-sponsored retirement and welfare benefit plans. ERISA benefits encompass a wide range of employee benefits provided by employers, including retirement plans (such as 401(k) plans, pension plans, and profit-sharing plans) and welfare benefit plans (such as health insurance, disability insurance, and life insurance).
Under ERISA, employers who offer these benefit plans must adhere to certain standards and regulations to ensure that employees receive the promised benefits and that their rights are protected. These standards include requirements for plan disclosure, reporting, fiduciary responsibilities, and claims procedures.
ERISA benefits provide employees with important protections, such as the right to receive plan information, the right to sue for benefits and breaches of fiduciary duty, and safeguards against the mismanagement or misuse of plan assets. Additionally, ERISA sets minimum standards for vesting, participation, funding, and benefit accrual to safeguard employees' retirement security.
Overall, ERISA benefits serve to regulate and protect various employee benefits provided by employers, ensuring that employees have access to essential retirement and welfare benefits and that their rights are upheld under the law.
What are the common reasons why ERISA benefits are denied?
Obtaining ERISA and long-term disability benefits can be challenging, as there are several common reasons why claims are denied, such as:
- Inadequate Medical Evidence: Insufficient medical documentation or evidence supporting the disability claim is a frequent reason for denial. Insurance companies often require comprehensive medical records and evaluations from qualified healthcare professionals to substantiate the disability claim.
- Failure to Meet Definition of Disability: Many disability insurance policies have specific definitions of what constitutes a disability. If the claimant's condition does not meet the policy's definition, the claim may be denied. This often leads to disputes over the interpretation of the policy language.
- Pre-existing Conditions: Some insurance policies exclude coverage for pre-existing conditions, or they may impose waiting periods before coverage applies. If the claimant's disability is deemed to be related to a pre-existing condition, the claim may be denied.
- Lack of Objective Evidence: Insurance companies may require objective evidence of the disability, such as diagnostic tests, imaging studies, or laboratory results. If such evidence is lacking or inconclusive, the claim may be denied.
- Failure to Follow Treatment Plans: Claimants are often required to follow prescribed treatment plans to qualify for disability benefits. Failure to comply with medical treatment recommendations or attend appointments can result in a denial of benefits.
- Missed Deadlines: ERISA and long-term disability claims are subject to strict deadlines for filing paperwork and appeals. Missing these deadlines can result in automatic denial of the claim.
- Substantial Gainful Activity: Disability insurance policies often require claimants to demonstrate that they are unable to engage in substantial gainful activity (SGA) due to their disability. If the insurance company believes the claimant is capable of performing work that generates income above the SGA threshold, the claim may be denied.
If your benefits have just been denied or terminated, you need to file an appeal with your insurance company. Under ERISA, you have 180 days to do so. This appeal will likely be your last chance to submit evidence in your favor, so it is important to take time before submitting your appeal.
Do I need to have an attorney in Indiana to help with my appeal?
We do recommend consulting with an attorney before submitting an appeal, but your attorney does not need to be located in Indiana. There is nothing specific to Indiana law that will affect your appeal. It is more important for you to have an attorney with expertise in ERISA long-term disability claims than for you to have an attorney in your specific state.
What happens if my appeal is denied?
If your appeal is denied and your case is governed by ERISA, you will have the option to bring a lawsuit in federal court.
What makes Indiana unique in a federal case?
Indiana passed Bulletin 103, which attempted to make dealings with insurance companies fairer by banning discretionary language. If an insurance company has discretion, it makes your case harder to prove. You prove that you are disabled and also, that the insurance company acted unreasonably. This is a difficult, though not impossible, standard to meet.
Unfortunately, Indiana’s discretion ban does not apply to ERISA benefit plans. So, if you received your disability plan from your employer. This ban will not help you and there is no real benefit to filing your lawsuit in Indiana.
Though most long-term disability cases are governed by federal law, our attorneys make sure to stay up to date on state laws that might affect your case. Accordingly, we are willing and able to help with your case in Indiana.
If there is ever a time that you need a local attorney, we will not hesitate to let you know. Contact Dabdoub Law today.