If you have a disability insurance policy from your employer, it is most likely governed by ERISA. (Employee Retirement Income Security Act.)
Your attorney fees can be recovered if you sue and win. It will be up to the judge to determine whether the insurance company should pay your attorney fees.
Under ERISA, a claimant need not prove that an insurance company exercised “bad faith” in making a benefit determination. Generally, a court should award benefits if the insurance company:
- Failed to engage in a fair and open-minded consideration of the claim.
- Based a denial of a claim on the findings of an in-house physician who did not himself use a scientific analysis.
- Rejected medical conclusions without properly following up with the evaluators.
While not all courts will award attorney fees, the standard is not a “bad faith” standard.
It helps to have a long-term disability specialist to evaluate your claim and make these arguments for you.
If you received a denial letter, give us a call. We’re happy to help, and we can connect you with experts who can tell you what will happen next.