ERISA Terms Explained

At Dabdoub Law Firm, we understand that the world of ERISA disability insurance can be overwhelming. The complex jargon and legal terms associated with ERISA disability claims often leave claimants feeling lost and confused. This is why we've taken it upon ourselves to simplify these terms for you. Our goal is to help you navigate your ERISA disability claim with confidence and ease.

ERISA

The Employee Retirement Income Security Act (ERISA) is a federal law that sets standards for employee benefit welfare plans including disability insurance, life insurance and even pension plans.

Plan Administrator

The plan administrator is the individual or entity responsible for managing the ERISA plan. This typically includes processing claims, providing information to participants, and ensuring the plan complies with ERISA regulations.

Fiduciary Duty

Under ERISA, plan administrators have a fiduciary duty to act in the best interests of the participants and beneficiaries. This means they must manage the plan prudently and avoid conflicts of interest. Should this fiduciary duty be breached, it opens the door for a robust legal response, reinforcing your rights under ERISA.

Summary Plan Description (SPD)

The SPD is a detailed document provided by the plan administrator that outlines the plan's benefits, rights, and obligations. It's crucial for claimants to read and understand their SPD as it serves as a guide to how their disability claim will be handled.

Denial Letter

If your ERISA disability claim is denied, the insurance company or plan adminsitaor is required to notify you in writing of the reasons for denial. This letter must provide the specific reasons for the denial and instructions on how to appeal the decision.

Appeal Process

Should the unfortunate circumstance arise where your claim is unjustly denied, rest assured that it's not the end of the road. The appeals process involves submitting additional evidence or arguments to support your claim. Under ERISA, you typically have 180 days to file an appeal after receiving your denial letter.

Standard of Review

If your claim goes to court, the judge will use a standard of review to evaluate the plan administrator's decision. This can be either de novo (fresh look without deference to the administrator's decision) or arbitrary and capricious (deference given to the administrator's decision unless it was completely unreasonable). Most ERISA disability insurance claims are evaluated under the arbitrary and capricious standard of review. It is a much more stringent standard of review and thus less favorable to the claimant.

Our Lawyers Specialize in Disability Insurance Claims

Because our law firm has always focused only on disability insurance, our lawyers are experts in legal representation for disability insurance benefits.

That means our disability lawyers have:

1. Won several major disability lawsuits that help make better law for disability claimants;

2. Experience fighting every major insurance company, such as UNUM, Hartford, MetLife, CIGNA, Prudential, and more.

3. Successfully represented hundreds of clients and won millions of dollars in disability benefits.

Because federal law applies to most disability insurance claims, we can help clients across the country.

Disability insurance companies have lawyers. You should too. Call Dabdoub Law Firm to get experienced disability lawyers on your side.

We can help with:

• Submitting a disability insurance claim;
• Appealing a long-term disability denial;
• Negotiating a lump-sum settlement; or
• Filing a lawsuit against your disability insurance company.

Call for a free consultation with a disability attorney. No fees or costs until you get paid.