ERISA Disability Lawsuits

What makes ERISA disability lawsuits difficult? 

Many claimants don’t realize the challenges they or their lawyer will be facing if an ERISA disability claim has to be litigated. It is crucial to understand that a case is often won or lost before a lawsuit is even filed. 

The main challenges in an ERISA lawsuit can be summed up as follows:

  1. No new evidence can be submitted
  2. There is no Live Testimony 
  3. No Jury Trial 
  4. The Court must defer to the Insurance Company
  5. No Punitive damages
  6. You can only recover back benefits owed
  7. The standard of review is pro-insurance
  8. There is no guarantee of Attorneys Fees

No New Evidence or Testimony can be submitted 

By the time a lawsuit is filed, the administrative record on an ERISA claim is closed. This means that no new evidence can be submitted to supplement the file. The final appeal submitted to the insurance company was your last chance to strengthen you case with additional medical evidence in support of your disability claim. 

In reviewing your case, the court will review only the information available in your administrative record to determine if your claim was wrongfully terminated. You will not be allowed to testify, so a judge will not hear your story. None of your doctors will be able to testify to support your claim and none of the insurance company’s doctors can be questioned on the stand. Your lawyer will not be able to take a deposition or cross examen in court the insurance company employee who made the decision to deny the claim. 

All of this means that you will be at a big disadvantage. Hiring an experienced lawyer to prepare a strong appeal before the final decision is made will help give you a better chance. 

Attorney Victor Peña accepts cases where he has not prepared the appeal although we are stuck with the evidence already contained in the record. It is possible to still attain a good outcome for a client if we can prove the insurance company’s review was unreasonable.

You Have No Right to a Jury Trial

Having a jury trial could greatly benefit a claimant, if you had a right to one. However, ERISA disability lawsuits do not come with the right to a jury trial. While this means you do not get the benefits of a jury trial there are also a few advantages to not having a jury trial. Trial dates can be set much sooner and looking at a Judge’s past rulings on other ERISA claims can give a good idea for how the Judge might rule in your pending lawsuit. This also means that the costs of litigation are much less that it would be with a jury trial. 

Remedies allowed in ERISA disability lawsuits 

Claimants are often disappointed when they learn what remedies are available to them if an insurance company loses on an ERISA disability claim. Particularly where the insurance company acted in a manner that, were the claim governed by state law, would subject the insurance company to bad faith damages. Bad faith damages are a familiar concept to many because they are often a source of large payouts in insurance lawsuits. However, these damages are not available in ERISA lawsuits. 

When a lawsuit is filed, the remedy being sought is a reinstatement of the claim and an order for the insurance company to pay all back benefits owed to the claimant plus attorney’s fees. However, in about half of ERISA lawsuits the court will “remand” the case back to the insurance company with an order that the insurance company perform another review of the claim. This leaves the claimant waiting for months for the insurance company to perform another review of the claim. Often, the decision ends up being the same. During all this time, claimants suffer many economic losses such as credit score drops, car repossessions and loss of their homes. Unfortunately, the insurance company cannot be held responsible for these losses. Moreover, no matter how bad or unreasonable the claim denial, there is no right to punitive or bad faith damages. Attorney’s fees can be awarded but they are at the discretion of the judge if the judge determines that the claimant had “some success on the merits of the case”. 

The Standard of Review

Perhaps the most difficult aspect of an ERISA disability lawsuit is the standard of review that a federal court will apply when reviewing a disability denial. The best standard of review for a claimant is the de-novo review. This means that a judge will conduct an independent review of the entire administrative record and make a decision as to whether the claimant is entitled to disability benefits. The worst standard of review, and most common, is the arbitrary and capricious standard of review. This standard goes beyond the de-novo standard and typically allows a judge to reverse an insurance company’s decision only if the judge finds the insurance company acted unreasonably. The judge must decide which standard applies and usually this depends on whether the disability policy contains a discretionary clause giving the insurance company discretion to interpret the terms of the plan and to determine eligibility for benefits. Several states have made discretionary clauses illegal and it is important that every case is reviewed for an argument to invalidate the discretionary clause. 

Victor Peña Law – The ERISA Disability Law Firm

Attorney Victor Peña has extensive experience handling ERISA lawsuits against every major disability insurance company. He has helped claimants recovery millions of dollars in disability benefits making a recovery in 99% of lawsuits filed. We have helped clients nationwide. 

Almost every aspect of your case can be handled by phone, video conferencing, or mail – making it easy to work with us. No matter where you are located within the United States, our firm will be able to help you get the disability benefits that you are entitled to.

In the event that your benefits are denied, don’t lose hope. We can give you the peace of mind in knowing that someone is fighting for your rights. The sooner in the process that our firm is retained, the faster that we can help get you your payments. Call Victor Peña Law at 954-515-5504 or contact us online for a free consultation today.