ERISA Claims & 5 Mistakes Made When Filing - Mistake #1
Updated: May 5
Over the next few weeks, we'll be discussing five mistakes individuals make when filing ERISA claims for long term disability and short term disability, life insurance, pension or retirement, and sometimes large medical benefit claims.
The first mistake is thinking you can represent yourself.
Now we've all heard the joke that a lawyer who represents himself or herself has a fool for a client. The reason for that adage is varied, but one of the reasons is that when you represent yourself, you lose your objectivity, and you're not best able to ascertain how to proceed. Many people make the mistake of thinking that if they handle their ERISA claim themselves, it will save attorneys’ fees, and that is one way to look at it.
However, you should ask yourself the following questions, answering truthfully, to determine whether you should represent yourself or hire an experienced ERISA disability attorney to handle your claim.
Question #1: Is my claim important to me?
Question #2: Do I handle these types of claims on a daily basis?
The insurer or the plan administrator, who is denying your claim, certainly handles these types of claims on a daily basis. They also deny them every day. Many people think that if they are nice and honest about their claim, then the insurer or plan administrator will pay the claim. That is not how it works. There are always a few people out there with fraudulent claims, but the majority of people making claims for various ERISA benefits that they're due to receive should honestly be getting those benefits. I have yet to represent anyone who is making any type of claim that I did not find to be well-based, and I've been doing this since 1992.
Question #3: Could there be future issues with my claim that need to be considered now?
What you do and what you say in the earlier part of the ERISA claim process has an effect later. You need to know all of the ins and outs of the ERISA claim process, so what you do now doesn’t have a bad taste later and hurt your claim.
Question #4: Do I know the law well?
Many people don't want to take the law into account when handling a claim for themselves. You have to take the law into account. Ignorance of the law is no excuse. Courts will not cut you any slack, just because you handled your claim yourself. They will hold you to the legal standard applicable and to the precedent that is out there that might be impacting your claim. You need to know the law well.
Question #5: Do I know what strategy to use with my claim?
You better. These claims follow a very specific claim process that's found both in plan documents and in the claim procedure regulations. The ERISA claim procedure regulations sets the floor or the minimum standards. Then, the plan document may impose things on top of that floor. You need to know what strategy to use in connection with that claim process. Some of that strategy involves knowing what documents to obtain, knowing what evidence to submit, and knowing what evidence to counter.
Question #6: Is it possible I will hurt or even ruin my claim?
If you don't do things right with the claim process, you can cause your claim to become worthless.
Question #7: Would it be better to have most of my benefit or lose all of my benefit?
Yes, a lawyer has to charge you something in order to perform services for you and your claim. That charge may be an hourly fee or a contingency fee, which applies to most of our cases. A contingency fee means we obtain a percentage of your benefit, and in charging that contingency fee, we have to take into account the labor required, the level of difficulty of the claim, liability issues, and a number of different matters. Many clients wish we didn't have to charge anything at all, but of course we wouldn't stay in business if we didn’t. So, you have to answer that question honestly. Would I be better off at least having most of my benefit rather than losing all of my benefit?
Hopefully, these seven questions help you in making a decision as to whether you should obtain experienced ERISA counsel in connection with your long term disability claim, life insurance claim, pension/ retirement claim, or your large medical benefits claim.