We worked closely with Susan to help her build her claim carefully and systematically with new, undeniable evidence far beyond what she had presented before. We proved that the premium for Jack’s life insurance policy was deducted from his pay and received by the insurance company until his death. Our investigation also disclosed 20 pages of email exchanges between the employer and insurer, demonstrating that Jack inquired specifically about all steps necessary to convert his coverage. We presented all this evidence to the insurer in an administrative appeal of Susan’s claim. However, they STILL refused to pay, claiming that Jack did not take the technical step of sending in a form requesting porting his life insurance coverage. We sued the insurance company in federal court, and finally, close to the time of a scheduled trial and faced with a likely federal court judgment against them, the insurance company agreed to pay full benefits to Susan. In the end, because Susan continued to fight, she was able to get her benefits and maintain financial security for her son and herself. It was an honor to help this wonderful lady overturn such an unfair claim denial. sled Into Lapsed Coverage rting’ or ‘Converting’ Coverage
NAVIGATING THE ERISA MAZE 2 Mistakes to Avoid in LTD Claims About 80% of U.S. LTD claims are governed by the federal ERISA (Employee Retirement Income Security Act of 1974) statute. With a few exceptions, ERISA governs all LTD claims involving insurance policies or plans offered as employment benefits. But handling an ERISA LTD claim is a complex minefield for the unfamiliar. Everything about it is different. An administrative appeal process must be exhausted before any lawsuit, and jurisdiction is exclusively federal, with its own odd procedural track. Disability insurance companies and their attorneys know how to use ERISA’s complexities to their advantage. But many claimants, and often their attorneys, don’t until it’s too late.
The two biggest mistakes we see are the failure to timely appeal and failure to put evidence into the administrative record.
Failure to Timely Appeal: Can’t I just bypass the appeal process and file suit? The simple answer is “no.” Written administrative appeal to the insurance company (or ERISA “Plan” if self-funded) that denied the claim is mandatory and must be filed within 180 days of receipt of the written denial. So, the same insurance company, which also pays benefits if it reverses itself, decides the appeal — crazy but true.
Sazon Grilled Chicken Thighs Inspired by AmbitiousKitchen.com
When attorneys and claimants miss the deadline, those claims are as dead as a prescribed claim.
Failure to Put Evidence Into the Administrative Record: Can’t I just file suit and get serious about building a case in federal court if the appeal is denied? Again, the simple answer is “no,” and that comes as a surprise to many after it’s too late. What makes the appeal so critical is that the federal judge in the lawsuit who follows an appeal denial cannot consider any evidence that was not properly made part of the record during the administrative process. ERISA cases get their own unique scheduling orders with almost no discovery allowed. So, the appeal is your last chance to gather, create, and build the best evidence to support your client’s case later in court. Whatever case you build (or don’t) is carved in stone before you ever file suit.
Ingredients • 1 1/2 lbs boneless
• 1/2 tsp garlic powder • 1/2 tsp oregano • 1/4 tsp cayenne pepper (optional) • 1/2 tsp salt • Freshly ground black pepper
skinless chicken thighs
• 2 tbsp olive oil • 1 tsp cumin • 1 tsp ground coriander • 1 tsp turmeric
Directions 1. In a large bowl, add chicken, olive oil, cumin, coriander, turmeric, garlic powder, oregano, cayenne pepper (if desired), salt, and pepper. Toss together to coat chicken; let it marinate for 30 minutes to 1 hour. 2. Preheat grill to 400 F. Grill chicken thighs for 6–8 minutes per side or until fully cooked and an internal thermometer reads 165 F. 3. Transfer cooked chicken to a plate and cover with foil to keep warm, then chop into bite-size pieces to use in salads, tacos, bowls, and more!
So, don’t miss your appeal deadline, and load the record with every bit of evidence you can gather or create.
Shoot us an email at BriefRecess@jpricemcnamara.com if you’d like to discuss how we approach evidence-building or if you’d like a copy of our book that describes our ERISA “Win My Benefits” Appeal Process.
(225) 201-8311 3
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