Individuals who become disabled and then run into insurance company resistance to paying benefits under their group plans often feel shock and disbelief. They may ask: Why have I been paying premiums all this time only to have my valid claim denied? How could my employer offer and promote coverage that doesn’t help me when I need it? How can this type of deception be legal? The unfortunate answers to these questions lie in the way current legislation regulates — or rather, fails to effectively regulate — the way ERISA insurers providing these plans do business and deal with disability claims. These group insurance plans are governed by the Employee Retirement Income Security Act of 1974, known as ERISA. This federal insurance law does not protect the consumer against unfair denials of benefits by ERISA insurers, and individual states have no authority to do so either.
Working to Counter Unfair Insurance Company Tactics Many ERISA insurers engage in very aggressive strategies to avoid paying benefits under their disability policies. These companies’ focus on profits often conflicts with your well-being if you suffer a serious physical impairment or psychological problem that impacts your earning capacity. Under ERISA, they have tremendous power and discretion to terminate benefits for a wide range of reasons and may employ tactics such as:
Bombarding your doctors with misleading questionnaires and other requests in an effort to get information they can use to deny your claim; Hiring independent medical examiners or other “experts” willing to provide opinions unfavorable to your case; Employing private investigators to gather photo or video evidence that can be presented as proof you are not incapacitated.
The best time to contact a disability insurance lawyer is when you are preparing to file a claim for benefits under your ERISA group plan. Terry Low and Anthony Canata know critical success strategies to apply on your behalf, and they can also help you examine other possible means of support for you and your family.