ERISA plans offset other benefits, like SSDI benefits and workers’ compensation benefits, which can cause very unfortunate results for unweary claimants.
The first thing to understand about the topsy-turvy world of ERISA disability benefits litigation is that the plaintiff has no right to take ordinary discovery after filing a complaint in federal district court.
With respect to the protection of employee benefit rights, the statute grants exclusive jurisdiction to the federal district courts for civil actions brought by a participant or beneficiary, but provides an exception for actions brought by a participant or beneficiary to recover benefits due to him under the terms of the plan, to enforce his rights under the plan or to clarify his right to future benefits.
ERISA does not set out he appropriate standard of review for actions under § 1132(a)(1)(B) challenging benefit eligibility determinations. Firestone Tire and Rubber v. Bruch, 109 S.Ct. 948, 952 (1989). Addressing that statutory gap, the Supreme Court in Firestone held that, “[c]onsistent with established principles of trust law…a denial of benefits challenged under § 1132(a)(1)(B) is to be reviewed under a de novo standard unless the benefit plan gives the administrator or fiduciary discretionary authority to determine eligibility for benefits or to construe the terms of the plan.” Id. at 956-957.
A person who is denied benefits after an initial application will receive a notice of denial explaining that she has 180 days to appeal the decision to the administrator who made the initial decision.
Most group long term disability plans require claimants to apply for social security disability benefits. In fact, administrators often offer to assist claimants by referring them to a company that will represent them.