Experience Counts

Why ERISA experience counts

You need an ERISA experienced attorney early in the claims process. Many times we will receive cases where another attorney has handled the claim’s appeal before we become involved. If anything can be said as a generalization, most of the attorneys who are not familiar with these types of cases will only send a letter explaining why the claim should be paid. A court may only review the evidence that was presented to the insurance company or administrator prior to the filing of the lawsuit. This is the evidence in your appeal of the claim denial. ERISA cases are harder than other cases. ERISA court decisions mean you will win only if you can prove that the insurer’s decision was unreasonable or irrational (“arbitrary and capricious”). This is a very difficult standard to meet. ERISA claimants are much less successful in cases where the arbitrary and capricious standard was applied. Some have estimated that only 28% of ERISA claimants were successful under this review. That is why you should call us for a free telephone consultation at (513) 891-8777.