There are many reasons why insurance companies deny claims. If you obtained your disability insurance through your employer, it is most likely controlled by ERISA, the Employee Retirement Income Security Act. Appealing a denied ERISA claim is a challenge that should not be undertaken without the assistance of an experienced attorney. 

The only issue on which to base the appeal is whether the company was arbitrary and capricious in denying your claim.

I have successfully handled ERISA disability benefits denial appeals and have won benefits for privately insured disability insurance policyholders. The majority of my cases are settled on terms that are very favorable to my clients.

I strive to educate people about these cases by providing answers to frequently asked questions about long-term disability claims.

Types of Claims

I have tried or favorably settled disability cases against the major long-term disability carriers in this country, and recovered hundreds of thousands of dollars. I have successfully obtained the payment of long-term disability

payments to persons suffering from:

• Multiple sclerosis

• Stroke

• Cancer

• Partial paralysis

• Unsuccessful spinal surgery

• Chronic fatigue

• Lyme disease

• Fibromyalgia

• Depression

• Fingertip psoriasis

• Side effects of pain medication

• Repetitive strain

• Arthritis

• Acromegaly

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I have successfully handled long-term disability claims against the following long-term disability insurers:

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• Cigna

• The Hartford

• Prudential Financial

• Berkshire

• Paul Revere

• MetLife

• Unum/Provident-Unum

• Broadspire

I have written on the effect of new federal regulations on processing long-term disability claims, which was published in the New Jersey Law Journal, and have lectured to the Association of Trial Attorneys of New Jersey, the New Jersey chapter of the National Employment Lawyers Association, and the Bergen County Bar Association.

I recently was able to persuade CIGNA to reverse its denial of benefit decision arising out of cognitive limitations following a stroke, and Prudential Financial to reverse its decision arising out of chronic musculoskeletal pain. The benefit value of these claims is in excess of $2,000,000.

The Long-Term Disability Claim Process in NJ

Long-term disability claims filed under insurance purchased or provided by your employer are usually governed by ERISA regulations. ERISA sets forth a procedure for resolving disability benefits claims.   
 

• Preparation of your claim: Because all evidence must be submitted to the insurance company prior to going to court or in combination with your initial claim, effective claim preparation is essential to success.   

• Filing the claim: It is not uncommon for insurance companies to initially deny long-term disability claims. However, if the claim is properly prepared, there will be a higher chance of success early in the disability claims process.   

• Your right to appeal: Normally you have 180 days from the date you receive notice of the denial of your claim to file an appeal. If you have not consulted an attorney, it is important that you seek legal assistance immediately in order to have ample time to prepare the appeal.

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I gather medical records, statements, and other information that support your diagnosis and explain how your condition limits your ability to work. If the appeal is won, I can assist with updates to the insurance company reaffirming your need for benefits during its ongoing monitoring of your claim.