Unfairness of ERISA claims
The reason for the lack of fairness and proper payment of claims in ERISA cases is that when an insurance company denies an ERISA claim, even if it is wrong, the most the court can do is force the insurance company to pay the claim as it should have paid in the first place. ERISA is The Employee Retirement Income Security Act of 1974.
The plan or insurance company many times after a denial of payment say to the claimant, “just send in a letter appealing your denial,” THIS IS A TRAP! You need an experienced ERISA attorney. Several respected federal judges have agreed:
“In the Court's experience, [inexperienced] lawyers for ERISA claimants all too often do not appreciate the importance of getting all their evidence in the administrative record. Thus, it is not uncommon for ERISA claimants, when they get to court, to discover they cannot use what they think is critical evidence.”
Acree v. Hartford Life & Acc. Ins. Co.
“Having recognized the difficulties posed by Plaintiff's position [of having little or no evidence in the file], the Court also recognizes that ERISA claimants may not have the advantage of legal advice or favorable referrals before the administrative process is complete, placing such claimants at a distinct disadvantage if discovery is not permitted on judicial review. For ERISA claimants not able or aware enough to hire legal counsel before the administrative process is complete, they likely enter into judicial review facing a loaded deck—a deck loaded with the expert opinions of those hired by the plan administrator.”
Abromitis v. Cont'l Cas. Co./CNA Ins. Companies.
“A pro se (“do it yourself”) claimant will be hopelessly outclassed [in an appeal to the disability insurance company] and will [likely] hit a brick wall each time.” May v. AT&T Integrated Disability.
We have potential clients write a letter and when months have passed and there is no action by the insurance company the potential client calls us. Generally, it is too late for us to help. Please call us before you write this letter. It can be a big mistake.
If that is all the insurance company can be held liable for, what is the incentive for the insurer to pay the claim? If suit it file the judge only reviews what you sent ot the inaurance company. You do not get a jury. You do not get a trial. The judge will uphold the denial unless it is arbitrary and capricious. Some say irrational. This is why you need help. Call us for a free telephone consultation at (513) 891-8777.