EMPLOYEE BENEFIT CLAIMS (DISABILITY, MEDICAL LIFE)
If you have short term disability, long term disability, AD&D or catastrophic injury coverage, medical or other insurance because of your employer, the for benefits claim probably falls under the Employee Retirement & Income Security Act of 1974 (“ERISA”). ERISA is a complex piece of Federal legislation that covers most employee benefit plans and how employers and their contractors (usually an insurance company) deliver those benefits to employees. This is therefore a very important law; for most Coloradans, their retirement or pension, insurance benefits (life, medical, disability, vision, dental) are earned through our employment.
Unfortunately, many lawyers are not familiar with ERISA, or the complexities of the ERISA claim process.
Do you really need an ERISA lawyer? In many cases you do. In many cases, having representation early in the claim process can be the difference between winning and losing because ERISA dramatically alters your common law rights. Most of these claims (including Long Term Disability, Short Term Disability, and medical and other benefits) have very short deadlines, and Court rules that determine what evidence can be considered. If you do not know what to do protect your rights early, you may lose your ability to effectively protect your claim.
Structuring an ERISA case correctly is essential. Under ERISA, you also lose your right to claim compensatory and other damages. It is therefore very important to structure your claim correctly in order to maximize the (limited) recovery possible. The attorneys at Silvern & Bulger, P.C. have the knowledge and experience required to properly manage your claim from the beginning of the administrative process; through litigation. This is critical because, on most cases, if the administrative process is not handled correctly the litigation will not likely succeed. The sooner you consult with an attorney, the more likely your chances for success.
However, and in some cases (employees of the government, non-profits and in other unique circumstances) employee benefits fall outside of ERISA. It is important for you to determine early on what type of employee benefit claims you have (as they may be treated very differently, and may involve very different damages). In other cases, you may have purchased the policy directly. In those cases, regular contract rules apply. In fact, the case is handled in a completely different way, because many of the rules and restrictions of the ERISA statute do not apply. You may even be entitled to compensation beyond the amount of benefits. For example, if the insurance company acts in bad faith, or unreasonable delays or denies payment, damages for delay may be available.
Do not wait to seek experienced counsel until it is too late! It is critical to know what type of policy you have — and what law applies — as soon as possible. ERISA drastically affects your rights. Under ERISA, you have no right to a trial, or trial by jury. Your case will most likely be decided based on how the claim was handled before suit is even filed.
We handle:
Long Term and Short Term Disability Applications;
Long Term Disability and Short Term Disability Appeals and Administrative Reviews;
Litigation of Employee Benefit Claims in State District Court (Adams, Arapahoe, Boulder-Broomfield, Jefferson and Denver Counties) and U.S. District Court, and the U.S. Court of Appeals, Tenth Circuit.
We have handled claims involving a wide variety of medical conditions including:
- Anxiety and Depression, and related mental health disorders
- Asthma/COPD
- Back injuries, and chronic back pain
- Bipolar disorder
- Brain injuries, Traumatic Brain Injury and concussions
- Cancer
- Cerebral palsy
- Chronic pain, including Lyme Disease, Fibromyalgia, Chronic Pain Syndrome-RSD
- Diabetes
- Epilepsy
- Heart Disease
- Herniated discs
- HIV/AIDS
- Inner-ear/Balance disorders, vertigo-tinnitus
- Knee, shoulder and joint disorders
- Leukemia
- Lung disease
- Lupus
- Morbid obesity
- Multiple sclerosis
- Neck injuries
- Neuropathy
- Osteoarthritis
- Parkinson’s disease and Dementia
- Post-traumatic stress disorder
- Psychosis
- Rheumatoid arthritis
- Seizure disorders and Epilepsy
- Spine injuries
- Stroke
Claims for benefits under ERISA for Long Term Disability or Short Term Disability are different then claims for Social Security. The rules are very different, and these cases are not handled in the same way. If you have a claims for Long Term Disability or Short Term Disability that are covered by ERISA, you should speak with an experienced ERISA lawyer as soon as possible. At Silvern & Bulger we are experienced with all types of insurance benefit claims, including those that fall under the ERISA statute. We handle both ERISA and non-ERISA insurance benefit claims, including Long Term Disability, Short Term Disability, medical and dental, and life insurance claims. However, ERISA claims are a highly specialized practice area. Because of our experience in handling ERISA cases, we are listed in the U.S. Directory of Boutique Law Firms, in the ERISA category.