Monday, November 26, 2012
“Your Disability Benefits Have Been Terminated.”
Working with insurance companies to maintain disability benefits is difficult. Even after your benefit claim is approved, which is a feat in itself, the insurance company usually has the right to request that: (1) your physician submits documentation of your progress and your expected return to work; (2) you provide updated medical records from all of your doctors; (3) you submit to an examination with one of the insurer’s own physicians; or (4) that you answer lengthy questionnaires about your activities, medical condition and financial records.
We set out below some ideas of what you should do if the insurance company for your employer-provided disability benefit plan sends you a letter letting you know your disability benefits are being terminated. But, importantly, there are attorneys (like us at the Law Office of Katherine MacKinnon) that specialize in helping people when they receive the dreaded, “your benefits are being terminated” letter.
“What Should I Do Now?”
1. Read the letter carefully. Read the letter the insurer sends to you explaining why it is denying or terminating benefits. What are the insurer’s reasons for denying the benefits? What does the letter say the procedure is for appealing that decision?
2. Make note of any due dates. A letter explaining that a company is denying or terminating benefits must outline the process which you must follow to appeal the decision. The letter should also tell you the date by which any action must be taken – be careful not to wait until the last minute to either contact an attorney for help, or begin working on an appeal yourself. The appeal is often a big undertaking.
3. Is the insurance company asking for something? While carefully reading the letter, notice if the company is asking for any information that was not submitted. Are benefits being terminated or just suspended for failing to have a doctor submit a form? Is paperwork missing? Maybe there is something simple the company is simply missing or asking you to complete that would fix the whole problem.
4. Write to the insurance company, and request copies of all your plan documents and a copy of your claim file. The company is required by federal regulations to provide you with “reasonable access to, and copies of, all documents, records, and other information relevant to the claimant's claim for benefits.” 29 C.F.R. §2560.503-1(h)(2)(iii). Since there is a time limit on when an appeal can be submitted or a claim can be brought in court, it is important to write and ask for these documents right away.
5. Administrative appeal. In some circumstances a person can put together their own appeal, and in some circumstances it is best to consult an attorney. An appeal is often your best and last opportunity to furnish the insurer with all relevant information regarding your disability benefit entitlement. The insurer needs and wants the information so that it can make an informed decision about whether you are entitled to benefits. Helpful information might include: all your medical records from each provider; a statement explaining your disability and how it affects your ability to work; letters from your doctors, coworkers, family members, or friends talking about your disability and inability to work; a videotape showing your condition and how it impacts you; your employment records showing how you struggled to work; any decisions from the Social Security Administration, other disability insurers, or other entities that considered you to be disabled.
Putting together an administrative appeal is a huge project, involving collection of many pieces of information from multiple sources. If you get confused or frustrated, you can always contact an attorney who specializes in ERISA benefits for help. Good luck!
Friday, November 16, 2012
What the Heck is ERISA?
Even after completing law school, most lawyers have no idea what ERISA is other than a vague impression that it involves employee benefits and that they should consult an expert if they encounter it. If you are not a lawyer, the first time you hear “ERISA” is likely to be only if you’ve been denied some type of benefit that was provided by your employer.
So what the heck is ERISA?
ERISA is an acronym for the “Employee Retirement Income Security Act,” a federal law enacted in 1974 that sets minimum standards for employee benefit plans including: pension plans, long and short-term disability plans, health insurance plans, life insurance plans and other types of employee benefits. ERISA requires plans to provide participants (typically employees or their dependents) with certain information about the plans such as what benefits are provided, how to apply for them and what to do if benefits are denied. The ERISA law also sets out standards of fiduciary conduct for those people who manage and control plan assets. The fiduciary standards are meant to assure that people who are plan fiduciaries act in the best interests of the plan participants as a group. ERISA also gives participants certain rights to sue for benefits or to sue if the fiduciary breaches a duty to participants.
What Does an Attorney who Focuses on ERISA Do?
As attorneys working on ERISA matters, we help people obtain benefits through their employee plans. This could mean helping a person with a disabling condition who cannot work apply for disability benefits. It could mean helping a person appeal to the insurer if they do not get approval for medical care they need. It might mean challenging the decision of a life insurance company if it denies the proceeds from an employer-provided life insurance policy. Practicing in the area of ERISA might mean assisting a retiree to get the correct amount of monthly pension payments after he or she retires.
Here at the Law Office of Katherine MacKinnon we really enjoy helping people get the benefits they need and are entitled to receive.
Friday, November 2, 2012
Hello! We are Kate MacKinnon and Sarah Demers from the Law Office of Katherine L. MacKinnon. We are attorneys in Minnesota practicing in ERISA employee benefits. Situations we commonly help with would be if you are:
· denied long or short-term disability benefits
· denied life insurance benefits
· are not getting the benefits due from a pension
· have been denied health insurance benefits
We are starting this blog to give our readers information regarding employee benefits, ERISA, news, and any other tidbits we think might be interesting or helpful.
We hope this turns into a great source of information for anyone facing a denial of employee benefits.COMING SOON...What to do if you've been denied benefits under an employer's plan. Have a good weekend!