Unique Challenges of Pursuing an ERISA Disability Insurance Claim in Florida

J.P. Gonzalez-Sirgo
Founder of J.P. Gonzalez-Sirgo, P.A.

Many people throughout Florida and the rest of the country own group disability insurance policies.  Policyholders presume that these policies provide a measure of financial protection when they suffer catastrophic injuries and illnesses.  If you have disability insurance through your employer, it is important to understand that the law favors your employer and the insurance company when you make a claim.  The reason that policyholders have limited rights in this situation is because the vast majority of employer disability insurance plans fall under the auspices of the Employees Retirement Security Act of 1974 (“ERISA”).

If you file a claim for disability benefits that is denied, you are required by ERISA to appeal the denial directly with the insurance company that denied the claim.  While many ERISA disability policies have a dispute process that includes multiple internal appeals, all such policies mandate that at least one appeal be pursued with the insurer.  A lawsuit cannot be filed challenging a denial of disability benefits under ERISA unless all internal appeals under the policy have been exhausted.  A policyholder contesting denial of disability benefits under a policy governed by ERISA also has only six months to complete the appeal process.  This is an extremely short window to gather the evidence and information you need to submit, so time is of the essence.

If your disability insurance claim involves a non-ERISA disability insurance policy, you can gather the evidence you need and file a lawsuit without first exhausting internal appeals with the insurance company that issued the policy.  Since appeals must be completed under ERISA within 180 days, filing a successful lawsuit is difficult because you must introduce all of the evidence you want to use in trial during the internal appeals.

The bottom line is that ERISA disability claims constitute a significant challenge to dispute because an insured has an unrealistically short period to gather evidence to present in the appeal.  When specific evidence is not presented at the appeal, the insured will lose the right to use the evidence at trial.  Because the odds are stacked against policyholders challenging denial of benefits under an employer provided ERISA disability policy, you should obtain legal advice from an experienced Florida disability insurance attorney as soon as possible.

If you think your disability insurance claim is being wrongfully denied or you are being mistreated by the insurance company, we may be able to help you obtain the benefits that you deserve.  We know that disability insurance defense attorneys and insurance adjusters use a wide array of tactics to derail policyholder claims.  My experience as an insurance claims adjuster and advocate for policyholders has equipped me with the skill and knowledge to fight for the benefits you paid premiums to obtain.  If you think you might need an insurance attorney for your claim or you have questions about your rights, my law firm represents policyholders in claims disputes in Miami and throughout Florida.  The Law Firm of J.P. Gonzalez-Sirgo, P.A. offers free case evaluations.  No Recovery, No Lawyer Fees.  Call 305-461-1095 or Toll Free 1-866-71-CLAIM.

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