Mark Humphreys law offices announce a recent settlement in two ERISA (Employee Retirement Income Security Act) cases in favor of clients. The laws of ERISA are governed by Federal Law rather than State Insurance Law. The laws are drastically in favor of the insurers.
One case involved a claim for Short Term Disability (STD) benefits and the other was for Long Term Disability (LTD) benefits.
The disability benefits were purchased by the employees through payroll deduction. These benefits, part of employee benefits packages, can also include health coverage and life insurance coverage.
There are a couple of unique features of ERISA cases: 1) the administrative process has to be completed before a lawsuit is allowed to be filed when there is an adverse ruling, and 2) a person making a claim is not entitled to a jury trial. Instead, a Federal Judge reviews the claims file and makes a final ruling. This ruing is usually based on whether or not the claims administrator abused his discretion in making his decision to deny the claim. It is extremely rare for the Federal Judge to change the determination of the claims administrator.
As to the two cases settled, the LTD case was resolved at the appeal level in the client’s favor. The law office did a detailed analysis of the medical records in the file and highlighting of points in the record that were in support of the client’s claim for LTD benefits. The highlighting of these records contradicted the reasons the plan administrator cited for the original denial of benefits.
As to the second case that was settled, which was for STD, this claim was still denied after the appeal to the plan administrator and a lawsuit was filed immediately. This case settled within in the client’s favor a month after the lawsuit was filed.