Most of you know I maintain contacts with attorneys across the country who keep me generally informed of trends and insurance actions that continue to be unfair and egregious.
For the last year or so, I’ve been hearing a great deal about claimants attempting ERISA appeals on their own because they want to save money. A small percentage of claimants feel they are “experienced”, and have access to sufficient information in order to win. Neither of these two thoughts about doing appeals on your own are actually true.
I know, I know. After I post this article I’m going to get emails telling me how some claimant, some where, did their own appeal and won. While that may be true, this person represents less than 1% of the ERISA folks who attempt appeals and actually win. Making the decision to do an ERISA appeal on your own is folly of the highest caliber and the probability of success is more than 1,000,000:1.
While readers may choose to think, “Linda’s all wet on this one”, let me say that as an expert on many ERISA cases, I can credibly make the following comments.
First, ERISA is an acronym for the Employment Retirement Income Security Act of 1974 and was passed by Congress to protect “welfare” plans from discrimination. Employer “Welfare Plans” include group health and disability Plans and retirement funding. Since 1974, ERISA laws have been amended, extended and restricted by the courts where “rule by precedent” has literally removed any actual protections ERISA might have originally afforded to employees.
In order to use ERISA to best advantage, it requires extensive legal knowledge, usually known to ERISA attorneys. The average lay person DOES NOT KNOW ENOUGH ERISA LAW TO PROPERLY PRESENT A CASE. Those claimants who are now thinking, “Oh yes I do……” should entertain the thought that they are most definitely wrong.
Let me also say that ERISA litigation involves constant writing and answering motion after motion. Motion for removal to federal court, motion for summary judgment, discovery motions, discovery denials, another motion to appeal, interogatories, etc. It is not enough today, to just submit additional information because you won’t win an appeal doing that. Why?
Insurance companies don’t care what your doctor says, and remember the old saying about insanity..” Doing the same thing over and over again and getting the exact same result?” Submitting old and more information is not sufficient to support an overturn of a denial decision.
And, I’m not in league with attorneys either. If you’ve read my blog for awhile you know I do not support attorney involvement in claims management. HOWEVER, claim appeals should be processed by experienced ERISA attorney who knows the law. Attorneys can also negotiate a settlement if it turns out to be the better solution.
Again, I realize people will either listen to the information given, or will not. Claimants who decide to enter into a process that requires significant knowledge of ERISA law are not likely to be successful…..for what it’s worth.