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faqs-on-erisa-disability

Each benefit claim is different depending on the facts of your case, the plan, and the benefits at issue. However, below are some frequently asked questions regarding ERISA disability claims. If you have further questions or your long term disability or ERISA disability claim has been denied, contact one of our experienced ERISA disability attorneys for a free consultation today.

1. What is ERISA? “ERISA” means the Employee Retirement Income Security Act of 1974 – a federal law designed to protect employees who are enrolled in retirement or benefits plans through their employment. ERISA requires accountability of plan fiduciaries and generally defines a fiduciary as anyone who (1) exercises discretionary authority or discretionary control over a plan’s management or exercises any authority or control respecting management or disposition of its assets, (2) renders investment advice for a fee or other compensation, direct or indirect, with respect to any moneys or other property of such plan, or has any authority or responsibility to do so, or (3) has any discretionary authority or discretionary responsibility in the administration of such plan. In addition to keeping participants informed of their rights, ERISA also grants participants the right to sue for benefits and breaches of fiduciary duty.

2. Who controls ERISA? According to the Department of Labor, there are three separate bodies that administer and enforce ERISA: the Employee Benefits Security Administration, the Internal Revenue Service, and the Pension Guaranty Corporation.

assembly-line-workers-disability-denials

Assembly line workers have physically demanding jobs. Most assembly line workers perform repetitive movements, frequently lift heavy objects, stand for long periods, bend/twist/kneel/stoop often throughout the day, and function under demanding time constraints. According to the Dictionary of Occupational Titles, Assembly Line Workers perform repetitive tasks on an assembly line to mass produce various products. Assembling components, using tools, and performing a combination of tasks on a repetitive basis are possible duties on a production line.

In our experience, common medical conditions typically suffered by assembly line workers include, but are not limited to:

  • Lumbar spine/back conditions
  • Degenerative disc disease
  • Bulging discs
  • Radiculopathy
  • Pulled muscles
  • Torn rotator cuffs
  • Fatigue
  • Fibromyalgia
  • Chronic pain
  • Carpal tunnel syndrome

It is important to know that ERISA disability policies often have a two-part definition for “disability.” Typically, an insurance company initially investigates to see if you can perform your regular or own occupation. However, after receiving disability benefits for a period of time (usually 24 months), the definition of disability may change. If that happens, the insurance company is no longer determining whether you can perform your own occupation. Instead, the insurance company investigates to see if you can perform any occupation. During this process, the insurance company often finds a less demanding job that it believes you can perform.

judge-orders-prudential-must-produce-documents

Attorney Elizabeth Thornsbury received a favorable Order in federal court against The Prudential Insurance Company of America in an ERISA case on September 4, 2019.  The judge granted Plaintiff’s motion to compel discovery stating that:

“Aliff may conduct some discovery to enable the Court to determine whether such conflict affected Prudential’s benefit decisions.”

Prudential had previously only answered part of Aliff’s discovery requests claiming that she was not entitled to all of the information requested. However, the judge continued to explain that:

austin-mehr-kentucky-law-update
Austin Mehr will be presenting for the Kentucky Bar Association Law Updates. Austin will be presenting throughout the state on the topic of federal insurance law on the following dates:

  • Friday, August 30 – Owensboro Convention Center
  • Friday, September 13 – Northern Kentucky Convention Center

life-insurance-claims-faqs

Life insurance can be purchased one of two ways, either through your employer, in which case ERISA applies, or from a private life insurance company. ​Our experienced bad faith insurance and ERISA lawyers can assist you when either types of these claims have been denied.

For more information on life insurance claims, read the FAQs below:

  • Why would an insurer deny my life insurance claim? There are many reasons given by insurers for denying a life insurance claim. Most denials arise from the language in the actual policy . The insurer may deny payment because of the particular cause of death, or because a death occurs within a certain period of time after the policy is issued. A claim may be denied based upon alleged misrepresentations in the application- such as a statement that the deceased person was of “good health”.. Typically, the insurer doesn’t double check on the accuracy of such statement until after someone dies, when they look through the medical records with a fine-tooth comb.
  • Can a spouse contest a life insurance beneficiary? It is difficult to contest a beneficiary designated by a spouse on a life insurance policy, but it is not impossible. There are many factors which could lead a court to invalidating or rewriting a policy to more accurately reflect what an insured intended or to canceling a policy which was issued inappropriately.
  • Can a beneficiary claim on a lapsed policy? Even if a life insurance policy is lapsed, there may be opportunities to make a claim under it. The terms of the policy will be a major factor in making that determination.
  • Can a last-minute insurance beneficiary change be contested? A court can undo a last-minute change in the beneficiary of a life insurance policy in some situations where it appears that the change was improper.
  • Who can change the beneficiary of a life insurance policy? Generally, the owner of the life insurance policy can change the beneficiary of a life insurance policy. The owner may not be the insured. The owner is designated by the policy and is generally, but not always, the person who pays the premiums.
  • How do you find out if a deceased person had life insurance? It is important to review the papers, documents, and records of a deceased person to determine whether there may be any life insurance on their life. It is also a good idea to check with their insurance agents, bankers, employers, and any associations or organizations in which there were a member. Whether the deceased had a safe deposit box is also an important determination to make.
  • How do you find out if a life insurance policy was paid out? The insurance company is the best source of information on whether a life insurance policy was paid out. Bear in mind, the insurance company may not disclose that information to just anyone. You might have to show them why you need to know.
  • What happens to life insurance policies with no beneficiary? Generally, life insurance policies with no designated beneficiary or no surviving beneficiary will be paid in accordance with their terms, usually to the estate of the deceased.
  • How does money get split between beneficiaries? Generally, the proceeds of a life insurance policy are paid amongst the beneficiaries as designated by the insured or the owner of the policy. Otherwise, it is split equally amongst the beneficiaries unless the policy provides otherwise.
  • Can a life insurance beneficiary be changed after death? The beneficiary of a life insurance policy cannot generally be changed after the death of the insured, except by court order or, if allowed by the policy, by the direction of some other document, or by virtue of the beneficiary being a trust or some other entity who can re-direct the proceeds.
  • Can I share life insurance benefits with my siblings? The beneficiary of a life insurance policy can do whatever they want with the benefits that they receive, unless restricted by some other document, such as if they are the trustee of a trust.
  • The insurer claims the deceased committed suicide, but they did not. Can I make them pay? This happens sometimes and suicide “exclusions” are not enforcable generally if the policy has been in force for a certain number of years. And certainly the circumstances of what caused the death can be challenged by a lawyer.
  • The insurer denied the payment of the claim but sent the premiums paid back to the family. Should I cash the check? No. Do not cash the check until you discuss with a lawyer experienced in life insurance law.
  • The insurer claims the application contains mistakes, but it was the agent’s mistake. Do they have to pay? Sometimes they will have to be bound by what the agent wrote down if the agent’s answers to questions aren’t what the deceased person actually told them.

faqs-on-long-term-disability

How do I apply for long-term disability benefits?

You must follow the process and procedure outlined by your long-term disability plan. Your employer’s human resource department is required to provide you with a summary of your plan and its benefits. They may be able to help you fill out the forms.

I received a letter saying my long-term disability benefits were denied. What should I do?

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