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Bridging the Gap with ERISA Benefits

Posted by David P. Martin | Jan 30, 2019 | 0 Comments

Many times, the client who appears in your office has two or more different types of claims after suffering a workplace or personal injury.

Mr. Smith (not his real name) was one of those clients. He suffered a workplace injury which ended his ability to work, at least for the near future. He went to see a lawyer to pursue his worker's compensation case. Worker's compensation had paid the weekly benefit for a while, but then, it was terminated. The extent of permanent disability was disputed. Counsel filed a lawsuit and took depositions. During one of those depositions, counsel discovered there was a long-term disability plan that covered all employees, which Mr. Smith knew nothing about.

Mr. Smith was in dire financial straits. He had no money coming in, his spouse had no job, and they had two children under five. Not long thereafter, they lost their home. They had amassed substantial credit card debt. Mr. Smith badly needed a “bridge” to cover the gap in income until his worker's compensation case could be resolved. Counsel suggested the client file a claim for long-term disability. It was denied. Counsel referred that case to our office to assist with the ERISA claim and the denial of his long-term disability claim.

We moved forward with the long-term disability claim. While it takes time to obtain the entire claim record, all plan documents, develop a strategy, and then work the case up with medical and vocational experts, we pushed it as quickly as possible. Because we have done this work exclusively for years, we are able to move quickly.

We prepared and presented an appeal to the insurance company. It was successful. We were able to get the decision reversed and the benefits paid. Mr. Smith was on the verge of filing bankruptcy when the monies were received. He and his wife were reduced to tears.

Mr. Smith's long-term disability benefit bridged the gap, so that his other claims could proceed. The other two cases were resolved, which offset his long-term disability benefits, reducing it greatly. But, those benefits enabled his family to survive.

The story is true (though the name has been changed), but it is not unique. It happens over and over again. And it doesn't just occur with long-term disability benefits. It is also true for accidental dismemberment benefits when the plan providing them is ERISA-governed.

It is unfortunate that many clients do not know all of their employer-provided benefits. Savvy counsel should determine what benefits are available, as the existence of these benefits can reduce the pressure to settle a case too quickly and, thus, too cheaply. Many clients suffer unnecessarily during protracted litigation or lengthy Social Security proceedings. The existence of these other bridges can help span the gap for struggling clients.

The Martin Law Group's ERISA case lawyers have been handling ERISA benefits claims for over 25 years. ERISA claims are our focus. Let us help your clients bridge the gap with ERISA benefits, so you can successfuly move forward with their other claims.

About the Author

David P. Martin

Senior & Managing Attorney


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