Why ERISA Insurers Are Working Against You

Tony CanataDisability InsuranceLeave a Comment

Individuals who become disabled and then run into insurance company resistance to paying benefits under their group plans often feel shock and disbelief. They may ask: Why have I been paying premiums all this time only to have my valid claim denied? How could my employer offer and promote coverage that doesn’t help me when I need it? How can … Read More

ERISA Disability and Social Security

Tony CanataUncategorizedLeave a Comment

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. They do this because SSDI benefits are typically included as a ‘deductible source of income’ under most plans, meaning that administrators can reduce the amount of any … Read More

Reimbursement Rights in ERISA Plans

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In “ERISA Offsets Other Benefits” we explained how a claimant suing for disability benefits can end up losing and then owing money back to the insurer. In that example, the plaintiff sues seeking payment of her disability benefits and loses, and the ERISA disability payer countersues to collect money from the plaintiff’s retroactive social security disability check that is owed … Read More

ERISA Plans Offset Other Benefits

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ERISA plans offset other benefits, like SSDI benefits and workers’ compensation benefits, which can cause very unfortunate results for unweary claimants. An ERISA disability benefit plan is a contract, written by an insurer and chosen by an employer to offer as a benefit to employees. Employees who join the plan have entered into a contract. Insurers write into that contract … Read More

There is No Ordinary Discovery in ERISA Litigation

Tony CanataUncategorizedLeave a Comment

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. On its face, an ERISA disability case looks like a contract dispute between the parties: the claimant has sought benefits pursuant to the disability plan and the … Read More

ERISA Preempts State Law

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There are very few things as embarrassing for a lawyer as being at the wrong court. This is certainly true if it is 8:50 a.m. and you are wondering why your case is not on the list at the courthouse you drove to automatically while your were half asleep. It is equally true if you file a suit in state … Read More

Disability Plans Not Subject to ERISA

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The ERISA statute excepts five types of plans from coverage under the statute in the “Coverage” section found at 29 U.S.C. § 1003(b): (1) government plans; (2) church plans; (3) plans maintained solely for the purpose of complying with applicable workmen’s compensation laws or unemployment compensation or disability insurance laws; (4) plans maintained outside of the United States primarily for … Read More

Fiduciary Responsibilities Relating to ERISA Disability Plans.

Tony CanataUncategorizedLeave a Comment

Congress enacted the ERISA statute expressly to protect employee benefits. Unlike wages, which employees receive directly, employee benefits are established and maintained by other entities, which maintain funds from which to provide benefits to employees in forms other than direct compensation. The entities in question may be tempted to act in ways that benefit themselves rather than the employees who … Read More