1. Can I sue for punitive damages under ERISA? It is very upsetting to lose my loved one but then see my claim denied.
2. My loved one just died. Do I have time to wait to file a claim?
3. How can I afford an attorney?
4. The life insurance adjuster is nice on the phone. Isn’t he supposed to be fair to me?
5. Can’t my lawyer just write a letter or two and win the case for me?

1. Can I sue for punitive damages under ERISA? It is very upsetting to lose my loved one but then see my claim denied.

The sting of ERISA is felt greatly with life insurance claims. The only remedies allowed under ERISA generally are benefits, interest on those benefits, attorney’s fees, statutory penalties, and equitable forms of relief. Part of the bargain worked out between Congress and employers when the ERISA statute was passed, was to remove extracontractual damages such as punitive damages and mental anguish damages from the remedies allowed under ERISA.
So unfortunately, the answer is “no” you cannot sue for punitive damages, even though the refusal to pay your life insurance claim was insulting or understandably upsetting to you. However, our experience with these claims allows us to use the full scope of the ERISA remedies available to seek maximum relief. There are duties and obligations that are required of plan administrators and insurance companies. Experienced ERISA counsel knows what is required and how to invoke and involve those duties, allowing you to obtain the best recovery possible for your case.

2. My loved one just died. Do I have time to wait to file a claim?

When someone has just lost a loved one and is grieving, it is very challenging to worry about things such as life insurance claims. Even though the claim may assist with some of the funeral expenses, it is often the last thing on the beneficiary’s mind. However, life insurance claims will have time limits on submitting a claim. Sometimes the time limits may be short such as 60 days. Policies and plans can be written differently, but courts will generally enforce the policy or plan however it is written.
If the claim is denied, there will likely be another time limit to appeal that denial through the administrative or claim remedies in the policy or plan. That time limit can be as little as 60 days as well. It is important to exhaust all administrative or claim remedies before a lawsuit is filed. Adherence to those time limits is critical even though it is perhaps one of the hardest times in your life. If you have any trouble, you need to alleviate this added burden and allow an experienced ERISA attorney to assist you.

3. How can I afford an attorney?

We are here to help. We try to provide fee arrangements that are flexible and meet the needs of clients. The vast majority of our clients receive experienced quality representation on a contingency fee basis. This means that if we do not recover your benefit for you we do not get paid. If there is very little in back benefits, we can still help! We may be able to spread payment of fees out of the benefit over time. This allows us to treat the case like a big case, and invest the money and time needed to make the case strong so you can win. In some instances, a client may have reserves and may desire to pay us on an hourly fee basis. That is offered as well.

4. The life insurance adjuster is nice on the phone. Isn’t he supposed to be fair to me?

Most life insurance claimants think that their claim will be handled fairly since the adjuster seems nice. However, that person knows it is her job to deny your claim! When your claim is denied it saves the company or plan money. In fact, some plans and insurance companies hire people who went through law school, and they will know how to deny your claim factually and legally. Adjusters are well trained to deny claims, and they do this every day. You are no match for them. You need an experienced ERISA litigator on your side to fight for the benefit you deserve.

5. Can’t my lawyer just write a letter or two and win the case for me?

No. Most of the time that would be no different than a doctor providing a Band-Aid when you have a serious illness. Plans and insurance companies have a cadre of professionals providing the support needed to deny your claim. They have doctors, nurses, lawyers and many other well-trained individuals. In order to prepare an appeal you must obtain the full claim file and many times parts will be unlawfully withheld without you knowing it. An in-depth review of that claim file utilizing legal and medical professionals is needed. You have to thoroughly know the basis for the claim denial. And then you must articulate the truth and show why the denial is wrong, and assemble medical, vocational and legal evidence to demonstrate this. This must be done with a view toward supporting the case in litigation in the event that the claim is still denied. You should run … not walk … from any attorney who thinks a simple letter is all you need. A diligent determined and quality effort is required.
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