Eliminate Disability Claim Mistake #1

Ben Glass

Attorney
(866) 735-1102 Ext 320

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When employees become unable to work because of illness or injury, they are often covered under a disability insurance policy or plan. These plans are usually governed by ERISA. This federal law presents many opportunities for mistakes by claimants, their doctors or the helpful people at human resources. In this series I will review the most common mistakes made. These mistakes can give the insurance company an excuse to deny the claim.

Mistake #1:

Assume this is just a breach of contract situation. It's not. Since most employer sponsored plans are governed by the Employee Retirement Income Security Act (ERISA) they are altogether a "bird of a different feather."

Make no mistake about it, in a typical "breach of contract case," the parties are on equal footing. In an ERISA denial of disability benefits case, the insurance company starts out with a huge advantage, handed to them several years ago the Supreme Court of the United States.

That advantage is called "discretion" and basically it means that unless the insurance company's decision produces (as one federal judge called it) a "huge guffaw," they win.