Disability Insurance Plans which are provided by your employer are governed under a Federal Law known as ERISA (The Employee Retirement and Income Security Act). Generally speaking, disability plans not provided by an employer are not subject to ERISA and are litigated in State Court. Richard Rizk is fully licensed in Federal Court as well as the State of Oregon.
- Punitive Damages (damages to punish) are generally unavailable under ERISA;
- Damages beyond what is set out in the contract ("extra-contractual damages" are generally unavailable under ERISA;
- ERISA claims are heard by Federal Judges (as opposed to Jurors) who are often un-sympathetic to claims of disabled persons;
- ERISA’s strict procedure and timelines for filing and appealing denials applies to employer provided disability plans.
- If the plan administrator is not given discretionary authority to determine plan eligibility, Judicial Review of an ERISA determination is narrow. In that case, the court must defer to administrative findings if "any reasonable basis" supports the administrative conclusion. On the other hand, if the plan does give the administrator such authority, the court will not give deference to the administrator's eligibility decision and will decide that question on its own.
Your outcome could likely depend on whether or not:
- 1. ERISA applies; and
- 2. A narrow or broad standard of review applies
Contact Richard Rizk today at (503) 642-2114 to help get your claim on the right track.
- 1. Prohibiting claims procedures that "Unduly hampers initiation or processing of a claim";
- 2. Requiring claimant notification of an adverse decision within 45 days;
- 3. Requiring a written denial setting out:
- a. Specific Reasons for denial;
- b. Specific Plan Provisions justifying denial;
- c. Describing additional information needed to perfect claim; and,
- d. Describing specific criterion relied on;
ERISA Appeal Procedures:
All ERISA plans must establish and maintain an appeal procedure which:
- a. Allows claimant 60 days after denial receipt to appeal;
- b. Provides an opportunity for claimant to submit comments, documents and records;
- c. Provides claimant with copies of all relevant records at no charge; and,
- d. Takes into account all information submitted;
ERISA Prohibits:Retaliation for pursuing an ERISA claim. In other words, legally you can't be fired for pursuing your rights under ERISA.
Attorney fees may be allowed to either party involved in an ERISA dispute. To determine whether attorney fees are allowed under ERISA, a judge will consider:
- The degree of bad faith;
- The ability of opposing party to satisfy the award;
- Any deterrence effect;
- Whether all plan beneficiaries will benefit;
- Whether a significant legal question will be resolved; and,
- The merits of each position.
Richard Rizk has both defended and pursued bad faith claims. He knows insurer's fears and common mistakes. Don't be in the dark.
Put Richard Rizk's claims experience to work for you. He resolves many disability claims without ever filing a lawsuit! Call (503) 642-2114 today as time limits apply to presenting and appealing ERISA (as well as non-ERISA disability claims).
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If you need a Disability Attorney, Personal Injury Attorney or Insurance Attorney in the Portland Metro area call Richard Rizk at 503-642-2114. Please feel free to look over our Case Studies.
