Legal Updates

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What is an Administrative Appeal?

You have applied for benefits under an employee benefit plan and you have received a letter from the insurance company or plan administrator informing you that your application for benefits is denied. Whether you are applying for disability, life, health or other benefits the letter advises you that you have a right to an administrative appeal or review of your claim. This article is about that process – what is an administrative appeal or administrative review; what are your rights and obligations; and generally how should you approach this process. […]

By | 2007-05-08T15:46:00+00:00 May 8th, 2007|Legal Updates|0 Comments

What Is ERISA?

In 1974, Congress passed a law that regulates your employee benefits. Known as ERISA (the Employment Retirement Income Security Act) this law covers your retirement, disability, health, life and other employment-related benefits. It details the responsibilities of your employer regarding your employee benefit plan, and it outlines the steps you can take if you believe your rights are being violated. ERISA is a Federal law. State laws will not apply since they are preempted by ERISA. However, if you are employed by a governmental entity then ERISA does not govern your employment benefits. (State laws of insurance “bad faith” may [...]

By | 2007-04-10T23:02:00+00:00 April 10th, 2007|Legal Updates|0 Comments

Accidental Death Benefits Denied By MetLife Because Insured Was Drinking and Driving

An accidental death insurance policy will pay benefits when the insured dies as a result of an accident. But when the insured dies in an auto accident with a high blood alcohol rate is that an accident? Metropolitan Life Insurance Company recently denied a widow life insurance benefits when her husband died in a single car accident while driving home from his brother’s house. Met Life claimed that since decedent had been drinking beer before driving that the accident was not an accident under the law. […]

By | 2007-04-09T03:31:00+00:00 April 9th, 2007|Insurance Companies, Legal Updates|0 Comments

Excuses Used By Insurance Companies to Deny Disability Claims

Every denial of disability benefits includes the language “your medical records do not support a claim for disability as defined in the Plan.” What does that mean and what can you do about it? Plenty. First you must understand that there are two issues presented in that often used excuse to deny benefits. The definition of disability in the Plan and your medical records. (The issues are the same in an ERISA Plan, Governmental Plan and Individual Plan). How Does Your Policy Define “Disability” […]

By | 2007-04-09T03:21:00+00:00 April 9th, 2007|Legal Updates|0 Comments
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