When you need to file an ERISA disability lawsuit because of a disability, you have two avenues you can take: Settlement or litigation. The two important things to know before you make that decision are that you usually get less if you settle, and litigation could take several years if you or the insurance company decides to appeal. If you have excellent medical documentation that shows you have an LTD – a long-term disability – you could benefit from an ERISA lawsuit instead of a settlement. With an ERISA lawsuit, you do not get a jury trial – a judge makes the decision. Thus, if your evidence of a long-term disability is irrefutable, the lawsuit might not take as long. A disability attorney at DiAttorney.com (Dell & Schaefer) can help you decide the best course of action for your situation.
Settling an ERISA Case
The quickest way to get benefits for an ERISA case is to settle. However, you will get less than if you file a lawsuit. The pros of this are that it takes a few months instead of a few years, and you know for certain how much you will get. Additionally, once you and the insurance company signs a settlement, the insurance company cannot take it back. This is important to know because some people may want to try to work. However, if you work, even in a different profession that pays much less than the profession you can no longer work in, the insurance company could deny your claim. Once both parties sign a settlement and you get your check, it is set in stone and the insurance company can’t change its mind, even if you do go back to work.
Litigating an ERISA Case
If you choose to litigate your case after an ERISA denial, several things could happen. We’ll go through each of the possibilities, but keep in mind that you never know what the court is going to do. These are just the scenarios that could play out.
The Plaintiff Wins
The best scenario is if the court rules in your favor. However, that doesn’t mean it’s necessarily over. The insurance company could file an ERISA appeal, which means that you have to go through the appellate process. If the Appellate Court agrees with the lower court, the insurance company could appeal to the Supreme Court. At any stage, you could win or lose.
If the insurance company does not file an appeal, that doesn’t mean that you get benefits from now until you retire. The court could order the insurance company to pay benefits, but the insurance company will continue to review your case. You would get the arrearages and possibly a week’s or a month’s worth of benefits. Then, there’s the possibility that the insurance company reviews your case and determines that you are no longer eligible for benefits.
However, if the court decides that you presented enough evidence to show that you are disabled for the long-term or permanently disabled, the court could order the insurance company to pay you until your retirement age.
The Defendant Insurance Company Wins
If the court rules in favor of the insurance company, you could appeal to the Appellate Court. The Appellate Court could rule in your favor. In this case, you have the same issue of having the insurance company review your case and then denying benefits a week, a month, several months or a year or more later.
If the Appellate Court rules in favor of the insurance company, you could file another appeal with the Supreme Court. If the Supreme Court agrees with you, you have the same issue of getting benefits until the insurance company reviews your case and determines that you are no longer eligible for benefits.
Again, any court could order that the insurance company pay the arrearages or it could side with the doctors and order the insurance company to pay you disability benefits until your retirement age.
The Court Remands Your Case
When a court remands your case, that means it found that someone did not do enough to prove the case. If the Appellate Court remands the case to the lower court, that means that it cannot determine whether the lower court’s ruling is correct or fair because the information is most likely missing, or because the Appellate Court found something the lower court overlooked. If the Supreme Court remands the case, it found something that the Appellate Court missed.
Keep in mind that the Appellate Court does not review evidence unless the evidence is new and came to light after the lower court’s ruling. Generally, a case is filed in the Appellate Court if the party that is appealing believes the lower court made a mistake in its ruling.
Once a court remands the case, the lower court must review all the evidence again, taking care to review the information the higher court requested. It should come back with a different ruling, but that is not always the case. Having a case remanded is good in that it usually means that the plaintiff won, but on the other hand, it also gives the insurance company another chance to review the information again, and possibly find some other reason to deny your claim. And, after a remand, you could go through the appeals process again.
We are a national disability insurance firm. If you are ready to file a disability claim or the insurance company has denied your claim, contact DiAttorney.com, a disability insurance lawyer, for a free consultation to review your claim or your denied claim.
You have several decisions to make, including whether to enter settlement negotiations or to go to litigation. We can help you make that determination, but we will not make that determination for you. Once we tell you about both processes, you will be able to ask questions about the processes to help you determine which way is best for you.
If you were already denied, you can also decide to try to negotiate a settlement or go right to litigation. Part of your decision should be based on how well your medical records show that you are going to be disabled for the rest of your life — or at least for the long term.