You’ve probably heard that the Romans, Greeks, and other peoples throughout human history were polytheistic, which means that they worship more than one god. I know that most people today are monotheistic, but if you ever get hurt, can’t work, and get denied disability benefits by your employee disability insurance plan, then you should contact The Ondrejech Law Firm to make an offering to the goddess of employment disability benefits: ERISA. She has the power to make your employer, the TV duck, the gecko, the waitress, or the former president from Fox’s TV series 24 pay your claim. ERISA can be kind of difficult, so you need an attorney who can please the goddess with timely correspondence, medical reports, and legal briefs. Then, if she’s so inclined, she can force those characters to cough up the cash and perhaps even pay your attorney fees. Please read below to learn about this lovely (in a bureaucratic kind of way) goddess.
How do I make my employer pay me the disability benefits to which I am entitled under my employee disability benefits plan?
Contact a lawyer who is familiar with the Employee Retirement Income Security Act of 1974 (“ERISA”) in order to show your employer that you should be paid on your benefit claim. This law applies to you if you become disabled and are unable to work while you are enrolled in an employee welfare benefits plan as part of your employment compensation. You will likely be entitled to a certain amount of money each month to help you get by – commonly about 50 – 70% of your monthly pay, depending on what you chose when you enrolled in the plan.
To obtain these payments, you will need to apply to the committee that your employer appointed to oversee benefit claims under your ERISA plan. The burden is on you, as the ERISA employee- claimant, to show that you are entitled to disability benefit payments under the terms of the ERISA plan. Often, this requires you to show medical evidence that you cannot work at all. Contact me at The Ondrejech Law Firm, LLC for a free initial consultation at 330-441-2027 to get help with your ERISA benefits claim.
Why wouldn’t my employer want to authorize these payments?
In short, to keep the money for itself and those working for the plan. More specifically, there are four main reasons that meritorious ERISA claims are denied.
First, the burden to show entitlement to benefits is on the ERISA claimant. This burden is heavy, often requiring medical evidence showing that the ERISA claimant cannot work. The ERISA plan will typically follow its own doctor’s opinion when evaluating whether to pay benefits. Unfortunately, those doctors are tacitly incentivized to find against disability so they can continue getting repeat business from the employer plan.
Second, the ERISA plan decision is reviewed under a highly deferential standard by the courts on appeal. Basically, in order to overturn a plan decision, a claimant must demonstrate that the plan acted in an arbitrary and capricious manner (i.e., the decision was irrational). No new evidence is allowed during the appeal to the court, and the claimant does not have a right to a jury trial in these cases. The case is litigated on legal briefs and the documentation that had already been submitted to the plan. Some plans may allow supplementation of the record at various phases, so you’ll need an attorney who can properly review the ERISA plan document. This document is a large insurance contract that governs the ERISA claim in most instances. Strict deadlines must be followed. Contact an attorney right away if you have been wrongfully denied.
Third, the company or committee that administers the ERISA plan is focused on safeguarding the money in the plan, not making sure that all employee-claimants are paid.
Fourth, claimants typically do not contest plan decisions because they mistakenly assume that they cannot afford to hire an attorney and appeal their decision to the courts. Due to these four factors, plans will often err on the side of denying claims, and they will commonly get away with it.
How can I afford an attorney to obtain a mere fraction of my monthly pay every month?
A few years ago, the Supreme Court of the United States stated that a claimant who attains some degree of success on the merits of his or her ERISA benefits claim is entitled to have his or her attorney fees paid by the plan. As a result, an attorney may be willing to accept the case on the renowned “we don’t get paid unless you get paid” fee arrangement, which is called a contingency fee.
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