How do I make my employer pay me the disability benefits to which I am entitled under my employee disability benefits plan?

            Contact a lawyer who is familiar with the Employee Retirement Income Security Act of 1974 (“ERISA”) in order to show your employer that you should be paid on your benefit claim.  This law applies to you if you become disabled, and unable to work, while you are enrolled in an employee welfare benefits plan as part of your employment compensation. You will likely be entitled to a certain amount of money each month to help you get by – commonly about 50% – 70% of your monthly pay, depending on what you chose when you enrolled in the plan.  To obtain these payments, you will need to apply to the committee that your employer appointed to oversee benefit claims under your ERISA plan. The burden is on you, as the ERISA employee- claimant, to show that you are entitled to disability benefit payments under the terms of the ERISA plan.  Often, this requires you to show medical evidence that you cannot work at all.  Please contact us at Frank J. Groh-Wargo Co., L.P.A. for a free initial consultation at 440-234-3990 to get help with your ERISA benefits claim.

            Why wouldn’t my employer want to authorize these payments, after all, it agreed to make these employee benefit payments in the event I become disable, and a portion of my paycheck is paid to the plan for just this purpose?

            There are four main reasons that meritorious ERISA claims are denied. 

• First, the burden to show entitlement to benefits is on the ERISA claimant.  This burden is heavy, often requiring medical evidence showing that the ERISA claimant cannot work.  The ERISA plan will take this evidence and conduct its own file review by sending this evidence to a doctor who is paid by the ERISA plan to conduct these reviews.  The committee will often follow its own doctor’s recommendations, which are implicitly incentivized not to find that you are disabled.
• Second, the ERISA plan decision is reviewed under a highly deferential standard by the courts on appeal.  Basically, in order to overturn a plan decision, a claimant must demonstrate that the plan acted in an arbitrary and capricious manner (i.e., the decision was irrational).  Furthermore, an ERISA appeal is an administrative appeal straight from the administrative record that was in place before the committee.  Typically, no new evidence is allowed, and there is no right to a jury trial.  The case is litigated on legal briefs and the evidence submitted to the plan administrator or insurer’s review committee.  Some plans may allow supplementation of the record at various phases, you’ll need an attorney who can properly review the ERISA plan document.  The plan document is a large insurance contract that governs the ERISA claim in most instances.
• Third, the ERISA plan administrators who determine whether plan employee benefits are paid, commonly known as ERISA plan fiduciaries, are focused on safeguarding the money in the ERISA plan, not making sure that all employee-claimants who deserve to be paid are paid.
• Fourth, employee-claimants typically do not contest plan decisions because they will assume that they cannot afford to hire an attorney and appeal their decision to the courts.  Due to these four factors, plans will often err on the side of denying claims, and they will commonly get away with it. 

If your benefit claim is denied, don’t delay.  Employee benefit plan deadlines are short.  Missing a deadline can be fatal to your claim. 

            How can I afford an attorney to obtain a mere fraction of my monthly pay every month?

            Earlier this year, the Supreme Court of the United States stated that a claimant who attains some degree of success on the merits of his or her ERISA benefits claim is entitled to have his or her attorney fees paid by the plan.  See, Hardt v. Reliance Standard Life.  This resolved a decades-long debate among the courts on the issue of whether attorney fees should be awarded to a prevailing party in an ERISA case and at what point someone is considered a prevailing party. 

            Frank J. Groh-Wargo Co., L.P.A. and attorney Mark Ondrejech practice employment law (including employee benefits law – ERISA claims), business law, real estate law, discrimination law, construction law, and civil rights law in Greater Cleveland, serving individuals and businesses in the cities of  Avon, Avon Lake, Bay Village, Beachwood, Bedford, Bedford Heights, Bentleyville, Berea, Bratenahl, Brunswick, Brecksville, Broadview Heights, Brook Park, Brooklyn, Brooklyn Heights, Chagrin Falls, Cleveland, Cleveland Heights, Cuyahoga Heights, East Cleveland, Euclid, Fairview Park, Garfield Heights, Gates Mills, Highland Heights, Hunting Valley, Independence, Lakewood, Lorain, Linndale, Lyndhurst, Maple Heights, Mayfield Heights, Mayfield Village, Middleburg Heights, Moreland Hills, North Olmsted, North Ridgeville, North Royalton, Olmsted Falls, Orange, Parma, Parma Heights, Pepper Pike, Richmond Heights, Rocky River, Seven Hills, Shaker Heights, Solon, South Euclid, Strongsville, University Heights, Valley View, Wadsworth,Walton Hills, Warrensville Heights, and Westlake. This includes individuals and businesses throughout the counties of Ashtabula, Cuyahoga, Geauga, Lake, Lorain, Medina, Portage, and Summit.

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