ERISA and Non-ERISA
Disability Claims and
Health Insurance Claims

Disability insurance companies have historically refused benefits to policyholders diagnosed with chronic pain disorders and fatiguing medical conditions, such as Fibromyalgia and Chronic Fatigue Syndrome (CFS), alleging that the pain is psychosomatic. Or, the insurance company may allege that the pain is not severe enough to prevent the employee from working. Recent studies have proven them wrong, yet benefits are still often initially denied and require an attorney’s assistance to recover them.

Krafchick Law Firm, PLLC, handles both individual policy claims and group disability claims with coverage provided by employers. If you are seeking benefits from a policy purchased by your employer, your legal claim will most likely be governed by a federal statute known as ERISA (the Employee Retirement Income Security Act). If you purchased an individual disability policy, your claim will be governed by your state’s insurance laws. There is a big difference between ERISA and non-ERISA claims. ERISA has very strict legal guidelines and limits the damages that can be collected. You cannot claim punitive damages, nor are you allowed a jury trial.

From Fatigued to Fantastic To read a chapter written by Steve Krafchick titled Surviving the Disability Insurance Process in the book From Fatigued to Fantastic, click here.

To avoid some of the legal pitfalls as you seek to gain benefits, do the following when at all possible. When you feel you are unable to work, but before you file a disability claim, consult your doctor. Your doctor will appropriately fill out forms that explain his or her diagnosis, the medical reasons you are unable to work, and the prospects of returning to work at your old job — or any other job. You will have to fill out forms as well, and sign releases that allow your insurer access to your medical records and other records. This is part of the legal process.

Do not assume, however, that filling out the forms, and doing everything your disability insurer asks to do, will be enough. The attorneys at Krafchick Law Firm, PLLC, have represented many clients who have faithfully answered every question posed and provided all information requested, yet still were denied benefits. If you choose, we can help guide you through this legal maze.

In addition, get signed statements from friends, family and co-workers supporting your claim. If your doctor agrees to write a more extensive report, make sure he or she understands the process. Hastily written reports create problems that can hinder rather than help your claim.

Understandably, this is a complicated process. Needless to say, there is a great benefit in consulting a knowledgeable attorney early in the process to help you perfect your claim. Unfortunately, few attorneys have devoted their practice to helping people secure their disability benefits.

The attorneys at Krafchick Law Firm, PLLC, have handled ERISA and non-ERISA disability claims for decades, and have helped clients nationwide get the benefits they deserve. The cases that prove to be the most difficult are cases that come in late in the process. The earlier our involvement, the better our chances to affect the content and success of your claim.

We will work to achieve favorable resolution for you without going to trial. However, that is not always possible. Krafchick Law Firm, PLLC, is experienced and well-regarded in negotiation and trial, and do all we can to achieve justice for our clients.