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Has Your Insurance Company Denied
Your Disability Claim?

Whether an insurance company, employer, union or other ERISA governed
plan has denied your insurance claim, we can help.

Long-Term Disability Attorney in Boston for Health Care Workers

Insurance claim denial in BostonAs a frontline healthcare worker, you know you are at risk to exposure to the coronavirus. Frontline health care workers must assume increased risk every day by exposing themselves to COVID-19. They must manage the stress of treating patients in isolation every day. At the same time, some health care workers must worry about securing sufficient personal protective equipment. 

You know the virus affects people differently. You know some people exhibit no or very mild symptoms. Others become very ill and take a long-time to recover. So far, researchers do not know the long-term physical effects of exposure to the coronavirus. Yet it’s safe to assume that frontline workers face the greatest risk of contracting the illness. For yet others, the negative effects of COVID-19 aren’t physical, but emotional. Some health care workers suffer from symptoms of addiction, anxiety, and depression. Some even develop symptoms of post-traumatic stress disorder (PTSD) from long work hours and witnessing terrible events.

Long-term disability plans provide coverage for both physical illnesses and non-physical illnesses. Long-term disability rarely needs to be linked directly to your job as the cause of your inability to fulfill your occupational duties. Long-term disability insurance is separate from workers’ compensation insurance. If you’re a Boston healthcare worker and find yourself among the latter, you may need legal help securing long-term benefits you earned as part of your job. To learn more about finding a long-term disability attorney in Boston, who can help you, keep reading.

You Are at High Risk on the Frontline Providing Health Care

Battling an insurance company alone isn’t easy. What is more, you’re most likely dealing with the physical or emotional fallout of the coronavirus. The frustration of dealing with an insurance company can add to anyone’s anxiety facing an illness and financial stressors. In many cases, it’s in your best interest to hire an experienced counselor to negotiate on your behalf. That said, choosing the right Boston attorney may be key to success.

Forging ahead in a seemingly never-ending battle is mentally taxing. In these instances, health care workers may find that they have a right to long-term disability benefits. If you’re a health care worker, you may believe that you have a right to disability benefits. If so, you should contact an attorney at once if you are having challenges in securing the benefits you earned. An experienced Boston insurance claim attorney can help you figure-out if long-term disability coverage is suitable for your situation.

Choosing Competent Legal Counsel.

When choosing a disability lawyer, it’s vital to select an attorney experienced in the field. You may already know a lawyer who has helped you in other matters. You may know the individual personally. But it’s not in your best interest to hire that individual to pursue your long-term disability case, unless that lawyer focuses in representing individuals in disability claims. Most long-term disability plans fall under the Employee Retirement Income Security Act of 1974 (ERISA). This is a federal law that sets minimum standards for most voluntarily established retirement and health plans and disability plans in private industry to safeguard individuals in covered under these plans. ERISA is a very tricky and unforgiving law. Enacted to protect the interests of employees, over-time ERISA has proved to be both a sword and a shield for insurance companies.

A handful of major insurers dominates the disability market. It’s vital that your attorney has the kind of credibility that comes with experience in working in this area of the law. Protect your interests with an attorney knowledgeable in disability benefits and ERISA. Given that you’re probably also experiencing financial stress, finding a lawyer who is willing to work with you on a contingency fee basis may best fit your needs. In simple terms, contingency fee means, you don’t owe a legal fee, unless the attorney’s efforts result in benefits paid to you. 

An experience ERISA attorney can help. A knowledgeable lawyer can help you to apply for disability benefits related to mental health issues. An experienced ERISA attorney can litigate your claim for benefits if the plan or insurance company will not provide the benefits you earned.

You Have Rights

The Secretary of Labor ERISA regulations provide for minimum standards to try to level the playing field. The law also requires plans to establish a grievance and appeals process. This requirement ensures that participants can access the benefits in their plans. It also gives workers the right to sue for benefits and breaches of fiduciary duty. 

Section 503 of ERISA, codified as 29 U.S.C. § 1133, demands that every fiduciary afford to a plan participant full and fair review of a denied claim. The section’s function is to create “a fair opportunity for judicial review, and with ERISA’s overall purpose as a remedial statute.” Santana-Díaz v. Metro. Life Ins. Co., 816 F.3d 172, 181 (1st Cir. 2016). The statute mandates “a process that permits a claimant to supply supplementary ‘written comments, documents, records, and other [related] information’ to the claims administrator. See 29 C.F.R. § 2560.503–1(h)(2).” Stephanie C. v. Blue Cross Blue Shield of Massachusetts HMO Blue, Inc., 813 F.3d 420, 425 (1st Cir. 2016). The heart of each ERISA claim is the administrative record. That is the record in the fiduciary’s possession before litigation begins, which the fiduciary maintains, and which forms of the basis of the litigation to follow. 

There is no hard and fast rule for what constitutes the administrative record. However, it is not just what the insurance company contends. The ERISA statute does not define what constitutes the administrative record. But the Secretary of Labor has through his regulations. The law on administrative record is at 29 C.F.R. 2560.503-1. The Secretary of Labor’s regulation provides when there is an adverse benefits determination, the party who made the decision—usually the insurance company—must provide you with relevant documents. You are entitled, ‘upon request and free of charge, [to] reasonable access to, and copies of, all documents, records, and other information relevant to the claimant’s claim for benefits[.]’“29 C.F.R. § 2560.503-1(h)(2)(iii)). You are also entitled to statements of policy or guidance about the plan, whether or not the administrator relied on the policy or guidance in making the benefit determination. 29 C.F.R. § 2560.503–1(m)(8)(iv). There is a lot more, but these are some basic protections.

Let Us Help You Navigate the Challenges of Long-Term Disability

Now you know more about finding long-term disability attorneys in Boston, Massachusetts. What you need now is an attorney who will make sure that insurers hold-up their end of the bargain. Jonathan M. Feigenbaum, Esquire, can help you access the long-term disability funds that you deserve. Our firm has helped people for more than 25 years navigating long-term disability plans and ERISA litigation. You can count on us to help you battle the big insurance companies. What’s more, we can help you to access the benefits that you paid for and earned.

Contact Jonathan M. Feigenbaum, Esquire today or connect with us online for help accessing your disability benefits in your time of need.

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