Doing your ERISA claim and appeal correctly–in full–is key to getting your life insurance benefits paid.
Doing your ERISA claim and appeal correctly–in full–is key to getting your life insurance benefits paid. An ERISA claim is a special kind of claim. The best way to think of it is that an ERISA claim is not a customer service event. An ERISA claim is not where the insurance company is trying to do everything for you, so you have a pleasant customer service event. An ERISA claim is based on what is easiest for the employer and the insurance company. You, and the beneficiaries, come last. The first concern is always what is easy for the employer and life insurance company to administer. This is a fancy lawyer way of saying, they just want to follow the paperwork in their file, they don’t want to have to learn about the overall of the situation, or review additional documents, or listen to what would be “fair” and “just” on your claim. It is very important to get a life insurance company all the information quickly on an ERISA claim.
The four biggest points to keep in mind when you hear ERISA applies to your benefits
- Get your claim in, following all the requirements for information and even notarization. The life insurance company won’t pay a claim that isn’t made in writing, on the correct form, with all the information answered, and notarized signature (if required). It isn’t good enough to call.
- Get any additional information the insurance company administrator or employment administrator asks you to provide. The administrators are very limited in what they will do to help you complete the claim. If there is something else needed to get the claim done, you need to do it, or explain why it can’t be done.
- Make a careful record of everything you do. While the insurance company should keep its files clear, that doesn’t always happen. So you need to be sure to have a careful record of the documents you send–and full copies–so you have anything that may be left out later.
- Don’t make any “empty” appeal. If you need to appeal, you need to add to the evidence or make different legal arguments on the insurance policy for getting paid. If you just “appeal” without more information, the appeal won’t be approved, and you won’t be paid. An experienced life insurance lawyer, like us, can figure out better evidence and plan arguments to make an appeal win. Since you only get one chance to appeal, you need to make it work.
ERISA is based on a 1970’s era law that was originally intended to protect employees who were owed a pension from their employer.
ERISA is based on a 1970’s era law that was originally intended to protect employees who were owed a pension from their employer. Over the course of years, insurance company lawyers have turned it into a benefits vehicle for the insurance companies. While you may care very much about your claim, the insurance company cares more about their costs to administer all the claims each year. The insurance company lawyers have turned ERISA into a shield for the life insurance companies, making it easier for them to not care, not investigate, and not focus carefully on your claim. These changes in what ERISA was intended to do, and what it actually does, now, require that you do everything you can to make your claim get paid, the right way, without expecting that you can add to your claim documents later, or in Court.
If you have questions about an ERISA beneficiary designation, it is important to get all the information to the administrator.
If you have questions about an ERISA beneficiary designation, it is important to get all the information to the administrator. That may include a marital settlement agreement or another document that addresses life insurance. It may include letters or designations that appear to have been submitted, but not shown in the insurance company file. It includes finding out if there was only an “electronic” designation and the exact circumstances about how that designation was supposedly conducted. When there is no actual signed designation document, there are additional questions that are raised, even if the electronic designation is in the ordinary practice of the employer. Knowing all these points is in the interest of knowing what went on, and the correct identity of the intended beneficiaries.
Most people don’t know the difference between their ERISA claim and their ERISA appeal
Most people don’t know the difference between their ERISA claim and their ERISA appeal–and why would any non-lawyer really know. But the difference can make all the difference between a claim being properly reconsidered, and paid, and a claim that is just denied, and rubber-stamped, denied on appeal. It is very important to work with a lawyer before your time to appeal any denial is up. Getting additional information, facts, pictures, arguments, whatever is possible to change the life insurance company’s first decision to deny the claim, those things need to be in the appeal. It is more like a case getting prepared for trial, but before Court, and without the tools of Court.
Please contact a real experienced life insurance attorney before your ERISA appeal is determined against you. A lawyer can help get additional evidence and arguments into an appeal. In the ERISA type insurance claims, the appeal is the last best chance to get the insurance company to reconsider its decisions, and to get your claim paid. The twist that most lawyers, and few people understand about ERISA, and employer purchased policies, is that going to Court after an appeal, when no one has worked to get all the evidence into the insurance company’s file, is a very short and empty process. Court’s have a different job and function differently than most people think, on ERISA policies, and the right kind of preparation, before going to Court, is absolutely necessary. Otherwise, the ERISA claim denied as a claim or denied as an appeal, won’t be reviewed for anything different in the litigation, and that will be the end of your hope of getting the benefits that are due you and your family. So, let’s work together, using our more than twenty years of experience together, and get this done right, so you get paid.