(This section is for information purposes only and is not to be understood as giving legal advice.)
IF MY CLAIM IS DENIED WILL THERE BE A JURY TRIAL?
If your long-term disability coverage was part of a group policy, it is governed by ERISA which does not provide for a jury trial.
SHOULD I HANDLE THE APPEAL MYSELF AND IF UNSUCCESSFUL THEN HIRE A LAWYER?
This is not advisable as there is no opportunity to introduce any additional evidence once the final decision is made and suit is filed, and if you are not experienced in this area, it is unlikely that you will know what information is needed.
WHAT IS THE LEGAL STANDARD OF REVIEW UNDER ERISA COVERED CLAIM?
It is necessary to show that the denial was arbitrary and capricious meaning that it lacked a reasonable basis, which is a difficult burden of proof for any litigant to overcome.
DO THE APPLICABLE STATUTES PROVIDE FOR THE PAYMENT OF ATTORNEY’S FEES?
Fees are awarded if you prevail, however, a number of factors must be satisfied the most difficult of which is proving bad faith, which requires more than a showing that there was an improper denial of the claim. Further, no fees are awarded for any work performed prior to the filing of the complaint.
HOW CAN MY CLAIM BE BARRED OR REDUCED?
A claim can be barred by a preexisting condition, or reduced by the payment of Social Security or workers’ compensation benefit payments. Also, many policies limit payment of psychological claims to only 24 months.
IS THERE GOVERNMENTAL DISABILITY INSURANCE?
The state of New Jersey provides disability income insurance for a period of six months, and if you are a state employee, disability pension coverage may be available. Social Security Disability Income coverage may also be available.
IF I HAVE BEEN AWARDED SOCIAL SECURITY DISABILITY INCOME INSURANCE DOES THIS MEAN THAT I WILL RECEIVE DISABILITY INCOME BENEFITS FROM MY DISABILITY INSURANCE CARRIER?
Regrettably, no. It is simply part of the mix of information to be considered.