Health & Disability Benefits

A company that breaks its agreement to provide health or disability insurance benefits not only violates the law, it creates fear and uncertainty for the future. Without coverage, a serious illness or catastrophic injury can bring financial ruin. We can help.

  • The law governing rights under health benefits plans is complicated, and in many cases, insurance companies do not know how to apply the law properly. A denial of coverage does not necessarily mean that the insurance company’s actions are correct.

    Increasingly, we see employee loyalty being repaid with denial of benefits when they need it most. Denial of benefits seems to be most common in claims related to long-term illnesses, preexisting conditions, pre-certification issues, and residential rehabilitation services for mental health issues and drug or alcohol addiction.

    If the company you work for provides health or disability insurance benefits, it must comply with ERISA (the Employee Retirement Income Security Act), a federal law that regulates the plans that provide these benefits, and it must keep its promises.

    Employers may have made promises to provide benefits for these conditions, and those promises may be enforceable under ERISA. For example, ERISA requires coverage of some preexisting conditions. The Health Insurance Portability and Accountability Act (HIPAA) limits a new employer’s health insurance plan from excluding coverage for preexisting conditions and prohibits discrimination against employees or their family members based upon prior medical conditions, prior claims, or genetic information.

    ERISA was enacted to set federal minimum standards for voluntarily established pension and employee benefit plans within the private sector and hold employers to strict rules intended to protect employees' rights to promised benefits. Participants have the right to sue to obtain promised health and disability benefits and for breaches of fiduciary duty. You may have rights to health, disability and other benefits and insurance coverage promised by your employer. Our attorneys stand ready to explain and help you obtain these rights.

  • If a disability prevents you from working, your long-term disability insurance or short-term disability insurance plan may entitle you to continued pay and benefits during your disability. If an employer provides these benefits, the benefit plan is most likely governed by ERISA, which sets standards with which the plan must comply, and requires that employers live up to their promises to provide disability insurance benefits.

    Unfortunately, it’s not always easy to get what you’re entitled to. It may feel like being "hit when you’re down" to be denied the disability or health benefits you need. Our attorneys are nationally renowned advocates for employees who have been treated unfairly and denied benefits.

    Even if your doctor states that your condition prevents you from working, you could be turned down for long-term disability insurance benefits. Everyone is subject to disabling conditions that could prevent us from working. Mental and emotional disability claims can be harder to document than physical conditions that x-rays or other tests may show. Yet, many people have these illnesses to a disabling degree. Among the conditions for which you may be entitled to long- or short-term disability benefits because of mental health claims are:

    • post-traumatic stress disorder (PTSD)

    • obsessive-compulsive disorder (OCD)

    • anxiety disorders

    • bipolar disorder

    • schizophrenia

    • depression

    • dementia

    Other serious illnesses that may be covered include congestive heart failure, carpal tunnel syndrome, chronic fatigue, kidney disease, osteoarthritis, back injuries, lung disease, fibromyalgia, chronic pain, hepatitis C, leukemia, paralysis, diabetes, asthma, cancer and lupus.

Know Your Rights To Health And Disability Benefits

Our experienced lawyers can help you determine what should be covered and help you fight for what you have been promised. You have a right to appeal a denial of benefits and to file a lawsuit if, after appeal, your benefits are denied. You also have rights to request and receive documents governing your entitlement to health benefits.

Our practice includes fully documenting your condition, filling out the necessary forms, and pursuing appeals with the plan administrator when necessary. Know your rights before you file an appeal with the plan. Many times, the failure to consult an attorney before appealing to the plan will limit your chances for success if you later decide to pursue your claim in court. It is important to know that if you need to take your case to court, you may be limited in your evidence to what you presented earlier in your appeal to the plan administrator. Going through the administrative claims processes without consulting an attorney and gaining an understanding of your rights is a mistake that may ruin your chances of ultimate success.

  • Many federal and state laws may protect your right to health benefits when you voluntarily or involuntarily leave your job or when there are changes in your life. They include ERISA, the Health Insurance Portability and Accountability Act (HIPAA), American Recovery and Reinvestment Act (ARRA), Unemployment Compensation Act of 2010, Newborns’ and Mothers’ Health Protection Act, Affordable Care Act (ACA), Genetic Information Nondiscrimination Act (GINA), Mental Health and Parity and Addiction Equity Act (MHPAEA) and, perhaps most prominent, Consolidated Omnibus Budget Reconciliation Act (COBRA).

    COBRA gives employees and their families the right to choose to continue their group health insurance benefits for a limited period of time after you lose your job, are terminated, voluntarily leave your job, retire, transition between jobs, or lose benefits because of a reduction in hours worked, death or divorce. COBRA requires group health plans with 50 or more employees to offer employees and their families the opportunity for a temporary continuation of health insurance coverage in certain circumstances. Some states have their own statutes with more liberal requirements. If you qualify for continued health insurance coverage, you may be required to pay the entire premium for health coverage, up to 102% of the cost to the insurance plan.

    COBRA requires employers and health plans to provide notice to an employee who may be losing their health benefits. COBRA also explains how employees and their family members may choose to extend their health insurance coverage. Life events, such as marriage, pregnancy, childbirth, adoption, legal separation, divorce, death or a dependent child becoming too old for coverage under the plan may affect your rights or your family’s rights to health benefits. COBRA and the Uniformed Services Employment and Reemployment Rights Act (USERRA) also allow military servicemen and servicewomen to continue coverage for themselves and their family under group health insurance plans.

  • The Uniformed Services Employment and Reemployment Rights Act (USERRA) protects civilian job rights and benefits for veterans and members of reserve components.

    If you leave your job to perform military service, you have the right to elect to continue your existing employer-based health plan coverage for you and your dependents for up to 24 months while in the military.

    Even if you don't elect to continue coverage during your military service, you have the right to be reinstated in your employer's health plan when you are reemployed, generally without any waiting periods or exclusions (e.g., preexisting condition exclusions) except for service-connected illnesses or injuries.

Our extensive experience helps us resolve many benefit denials without having to file a lawsuit. But if that option is not available, we’ll discuss the possibility of filing a lawsuit against your employer and if necessary, vigorously litigate in court on your behalf if your health and disability benefits are wrongfully terminated or denied.

Recent Health & Disability Benefits Cases

  • Health benefits claims for residential drug and alcohol treatment. We successfully settled a lawsuit involving denial of a claim for in-patient drug abuse treatment for an employee’s dependent teenage child.

  • Health benefits claims for residential treatment for mental health issues. After an insurance company denied the claims, we obtained a favorable settlement for a high-level employee who sought in-patient residential treatment for mental health issues.

  • Health benefit claims for pre-existing conditions. We successfully litigated claims challenging a plan’s HIPAA and ERISA violations regarding preexisting condition limitations.

  • Health benefit claims for transplant expenses, treatments labeled as experimental, and treatments claimed to be excluded or in excess of policy limits. We successfully handled claims involving denial of health or disability insurance benefits. Issues included denial of transplant benefits and claims that benefits were excluded or in excess of policy limits.

  • COBRA violations. We successfully represented employees whose claims for benefits under COBRA were denied or delayed.

  • Health benefits claims denials, including denials for preexisting conditions, failure to pre-certify, coordination of benefits, and out-of-network benefits. We filed administrative claims and brought lawsuits on behalf of employees who were denied health benefits for preexisting conditions and failure to pre-certify certain treatment.

  • Claims for short-term and long-term disability insurance benefits. We successfully resolved administrative claims and lawsuits challenging denials of short- and long-term disability benefits. For example, we recently obtained a favorable settlement of a claim for short-term disability benefits for an employee who, due to severe depression, became unable to work for a period of time. We have also successfully settled claims associated with bipolar disorder, fibromyalgia, back problems and cancer for employees whose benefits had been terminated.

  • Retiree health benefits. In Gould v. Lockheed Martin Corporation, we successfully brought claims for retiree health benefits for union employees after the company threatened to discontinue and reduce retiree health benefits. Martin & Bonnett obtained a settlement for past and future Medicare reimbursement for class members, as well as continued medical coverage for the class of retirees and their dependents