ERISA Critical Illness Insurance Claims | What Claimants & Attorneys Should Know
Critical illness insurance is often marketed as a financial safety net after a major medical diagnosis. But when these policies are offered through an employer-sponsored benefit plan, they are frequently governed by ERISA (the Employee Retirement Income Security Act of 1974). That distinction matters—because ERISA fundamentally changes how claims are evaluated, denied, and challenged. What […]
ERISA Penalties: What Happens When Plan Administrators Fail to Provide Documents
If you’ve requested plan documents related to your long-term disability (LTD) benefits and received silence in return, the law may be on your side. Under 29 U.S.C. § 1132(c)(1), a powerful enforcement mechanism of the Employee Retirement Income Security Act of 1974 (ERISA), plan administrators can face steep financial penalties for withholding information. What Is […]
When Doctors Won’t Prescribe Physical Restrictions: Navigating LTD Claims with Conditions Like Fibromyalgia and Autoimmune Disorders
When you suffer from fibromyalgia, an autoimmune disease, or another chronic condition, long-term disability (LTD) benefits can be a financial lifeline. But qualifying for LTD benefits under an ERISA-governed plan often requires more than just a diagnosis—it requires proof that your condition limits your functional capacity. Unfortunately, that’s where many legitimate claims begin to unravel. […]
Understanding TSA, FCE, and Vocational Assessments in ERISA Long-Term Disability (LTD) Claims
When filing or appealing a long-term disability (LTD) claim governed by ERISA, claimants often encounter a variety of evaluative tools used by insurance companies. These tools are used by the insurance companies like Lincoln, New York Life, Unum, and others, to try and establish that the claimant is not disabled or that the prescribing physician’s […]
The 8th Circuit’s Evolving Standard of Judicial Review in ERISA Long-Term Disability Cases
Unlike most breach of contract cases or cases involving insurance, where the standard of judicial review is de novo – i.e. the court gets to determine whether or not a breach has occurred or if the beneficiary is entitled to the disputed benefit – under ERISA claims what standard of review is to be applied […]
Can ERISA Plan Administrators Recover Overpaid LTD or Health Insurance Benefits?
Plan administrators for health and disability insurance governed by the Employee Retirement Income Security Act (ERISA) often seek reimbursement when a beneficiary receives a third-party settlement or is otherwise overpaid. But the ability to recover those overpaid long-term disability (LTD) or health insurance benefits isn’t absolute. The U.S. Supreme Court has clarified — and restricted […]
Understanding the LTD Claims Process Under ERISA: Navigating 29 C.F.R. § 2560.503-1
If you’re pursuing a Long-Term Disability (LTD) claim, understanding the legal framework governing the claims process is crucial. For employees and claimants dealing with LTD benefits, the Employee Retirement Income Security Act (ERISA) provides important protections and clear procedures that insurers must follow. One key regulation is 29 CFR § 2560.503-1, which outlines the mandatory […]