If you have a group employer-sponsored disability policy, it will be subject to the federal Employee Retirement Income Security Act, commonly known as ERISA. Under ERISA, the rules of the game are different for enforcing your rights under your disability policy than they would be if you had an individually-purchased policy. You have to jump through different “administrative” hoops and your rights in court are limited. It is important, therefore, to make sure you know what you are doing when applying for disability benefits. Of course, it is never too soon to contact an attorney who is experienced in ERISA disability benefits law to guide you through the process to help make sure your claim is properly considered and if wrongfully denied, successfully challenged in court. Here is a list of important points to know:

• Contact your HR Department or benefits advisory at your employer as soon as you are aware of an actual or potential disability and obtain all of the necessary forms for making your claim for benefits. Most policies have time deadlines, so it is important to apply as soon as possible.
• Make sure your doctor knows your job requirements and understands your disability so that he/she can fill out the insurance forms fully and adequately. Insurance companies frequently rely upon technical oversights and/or incomplete statements in the attending physician forms to deny benefits.
• Supply your insurance company with all of your medical records from any and all health providers concerning your disability. Make sure the insurance company’s file is as complete as possible because the courts will only be able to review what is in your file if you later need to challenge any denial in court.
• Never refuse to provide the insurance company with any financial information or medical information it requests. Your claim can be denied simply based upon your failure to cooperate.
• If your claim is denied, you have the right to “appeal” that determination and request another opinion from the insurance company. You are not permitted to challenge the denial in court unless you first appeal all denials through the insurance company appeal process. It is very important to understand precisely why your claim was denied so that you can submit the right response. It is critical to seek the assistance of an experienced lawyer at this point so that the insurance file is in the best posture for you.
• Whether you hire a lawyer or not, you have the right to obtain from the insurance company the complete file on which it relied in denying your claim. You should ask the insurance company for it and obtain it before submitting subsequent appeals.
• Ask the insurance company for its claims procedures and/or rules for reviewing claims. Most companies have these, but try to avoid providing them. Very often a review of the procedures and/or rules reveals that the insurance company has not followed its own internal requirements or guidelines in reviewing and denying the claim, which can provide a ground to overturn the determination.
• If the insurance company denies your appeals, you have the right to seek your benefits by going to court. An experienced attorney will be able to advise you whether your case is appropriate for legal relief. Many lawyers will work for you on a “contingency fee” basis, meaning they do not charge any fee unless you win the case. Ask the lawyer whether he or she will be willing to take the case on a contingency basis.
• If your policy contains a provision that gives the insurance company “discretionary authority” to review and determine your claim, the court will only consider whether the insurance company’s decision was rational or reasonable - it will not consider the evidence to make its own determination of your claim. A new ruling by the New York State Insurance Department has found these types of provisions to be against New York’s public policy, so you may have a way to challenge such a clause.
• When the time comes, be reasonable in evaluating all settlement offers, but make sure your lawyer advises you of all of the strengths and weaknesses in your case before making your decision.

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The foregoing is not intended as legal advice for particular claims or actions and should not be relied upon without appropriate consultation with experienced legal counsel. Before taking any action, it is recommended that experienced legal counsel be sought.