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This program was recorded on September 18, 2018
The purpose of this course is to introduce legal professionals to long-term disability (“LTD”) insurance policy claims under the Employee Retirement Income Security Act (“ERISA”). ERISA is a federal law that governs a vast majority of employee benefit claims. When private employers provide long-term disability insurance to employees as an employee benefit, and employees become disabled and make a claim for those disability insurance benefits, those claims are governed by ERISA.
Born in Oregon and raised in Washington State, Chris Roy graduated cum laude from Gonzaga University in 1993 and obtained his law degree from the University of Oregon in 1998. Working in both the public and private sector, Chris started Roy Law in 2009 with a focus on representing people who have been denied disability insurance benefits. Chris has handled hundreds of disability insurance cases at all stages including applications, appeals, and litigation. Approximately seventy-five percent of Roy Law’s cases are devoted to ERISA-governed long-term disability insurance disputes, with the majority of clients being located on the West Coast and within the federal jurisdiction of the Ninth Circuit Court of Appeals.
2 General Credits
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- Overview of ERISA: Statutory and Regulatory Scheme
- Determining what laws, ERISA or state laws, apply to an LTD claim
- How ERISA affects the claim: Compare and contrast ERISA vs. state law claims with an emphasis on ERISA claims
- Stages of an ERISA LTD benefits claim
- Initial claim procedures
- Appealing a denial of benefits
- Litigation: Seeking judicial review of a appeal denial
- Issues in ERISA LTD benefit applications
- Understanding the key elements of an ERISA LTD plan: First, need to determine what is the plan.
- Understanding what you need to prove to obtain benefits.
- Understanding Proof of Claim requirements.
- Issues in ERISA LTD benefit appeals
- Understanding the regulatory framework, including timelines deadlines, the claimant’s right to the claim file and plan documents, etc.
- Understanding the insurance company’s obligations related to the content of the denial letter, conducting a full and fair review, and the content of an appeal denial letter (if applicable).
- Understanding the claimant’s responsibility to prove their claim and cooperate with the insurance companies investigation.
- Understanding the importance of the appeal and the content of the claim file.
- Issues in ERISA LTD benefit litigation under 502(A)(1)(b)
- Understanding the limitations period for bringing a lawsuit
- Understanding the lawsuit- judicial review of the insurance company’s decision.
- Understanding ERISA’s savings clause.
- Understanding discretionary clauses.
- Understanding the importance of venue.
- Compare and contrasting the process of litigating a case under abuse of discretion review vs. de novo review
- Modern Trends
- States are outlawing discretionary clauses
- Tension in the common law between trust and contract theories
- Movement by insurers to provide more and more contractual limitations
- Remedies under 502(A)(1)(b)
- Challenges with unpublished opinions and the wide variety of persuasive authority available