If your disability, life, or health insurance benefits were denied under an employer-sponsored plan, finding the right attorney is one of the most important decisions you will make. These cases are governed by the federal ERISA statute, which has its own rules, deadlines, and procedural requirements. An attorney who does not concentrate in this area can miss critical steps that can affect your outcome. This guide covers the criteria DeBofsky Law believes matter most when selecting counsel for a benefit denial case.
Additionally, even if you have a lawyer connection, not every attorney is equipped to handle your specific needs. Just as you wouldn’t enlist a divorce lawyer for a criminal case, selecting the appropriate attorney for benefit claims requires careful consideration. Accordingly, in this guide, we will equip you with strategic tips for choosing the right benefits denial lawyer. But first, let’s review the reasons why the right legal representation is critical to your case.
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Why Does the Right Lawyer Matter
The Right Legal Counsel Significantly Enhances Your Benefits Claim’s Chance of Success
Finding the right lawyer and not just any lawyer is critical to the success of the claim. The right lawyer will know how to analyze the insurance company’s rationale for denying benefits, identify what is needed to turn the claim around and assist the claimant in securing the necessary evidence. And, the right lawyer anticipates the insurance company’s response to a claim appeal and will carefully build a record for a possible lawsuit if the appeal is not successful and is ready to go to trial on day one.
On the other hand, the wrong kind of lawyer may lack the necessary experience or expertise to address the client’s unique issues and to know what courts are looking for to prove the insurance company’s decision was wrong.
While no reputable lawyer can guarantee a favorable outcome, the right lawyer will do everything necessary to enhance the probability of success.
How Do You Choose the Right Lawyer to Help You Get the Benefits You Deserve?
So, if you’ve wrongfully been denied disability, health, or life insurance benefits, what criteria should you prioritize to find the right attorney for your situation?
1. Look for a Lawyer Whose Practice is Concentrated in Handling Benefits Claims
Most disputes concerning disability, life, and health benefits arise from employer-sponsored plans, typically governed by ERISA law. It’s crucial to engage a lawyer whose practice centers on benefits claims. While Social Security lawyers deal with disability claims, they might lack the expertise required for an ERISA disability benefit case.
Our practice exclusively revolves around disability, life, health, and benefits-related cases since the 1980s.
2. Assess Experience and Track Record
While every case is unique, recurring issues demand experience and a proven track record. Seek out a lawyer who has not only handled cases akin to yours but has also secured favorable outcomes. Look for appellate court experience, indicating a lawyer’s prowess beyond initial trial outcomes.
Our firm boasts a history of successful litigations spanning more than 25 years, with notable victories detailed on our website. Here are a few:
- Fontaine v. Metropolitan Life Ins. Co., 800 F.3d 883 (7th Cir. 2015). ERISA Claim – Court of Appeals found that Illinois Insurance Regulation 50 Ill. Admin. Code § 2001.3 was not subject to ERISA preemption and precluded applicability of arbitrary and capricious standard of review.
- Raybourne v. CIGNA Life Ins. Co. of N.Y., 700 F.3d 1076 (7th Cir. 2012). ERISA Claim – Court of Appeals upheld district court ruling finding insurer improperly terminated disability benefits – The court found the Social Security disability benefit determination was not properly taken into consideration by the insurer, that the insurer was motivated by a financial conflict of interest, and that the insurer’s reliance on an independent medical examination was misplaced. The court also upheld an award of attorneys’ fees to Raybourne’s counsel.
- Stephan v. Unum Life Ins. Co. of America, 697 F.3d 917 (9th Cir. 2012). ERISA Claim – Court of Appeals overturned district judgment in favor of insurer – The court found Unum’s interpretation of the term “earnings” was arbitrary and capricious; the court also applied the fiduciary exception to attorney-client privilege to permit the discovery of communications between claim analyst and in-house counsel during the course of claim administration.
- Holmstrom v. Metropolitan Life Ins. Co., 615 F.3d 758 (7th Cir. 2010). ERISA Claim – The Court of Appeals overturned the district court denial of disability insurance benefits recognizing the significance of pain in disability assessment and criticizing the insurer for presenting the claimant with a “moving target” as to what evidence to submit.
- Diaz v. Prudential Insur. Co. of America, 499 F.3d 640 (7th Cir. 2007) and 422 F.3d 635 (7th Cir. 2005). ERISA claim – The Court of Appeals overturned district court rulings for the insurer finding that the court should not have given deference to the insurer’s findings. The court overturned two prior rulings and set a precedent regarding the standard of review applicable to ERISA claims and the method of adjudicating ERISA claims.
- Feibusch v. Sun Life, 463 F.3d 880 (9th Cir. 2006). ERISA claim – The Court of Appeals overturned the district court ruling for the insurer and ruled that the lower court improperly applied the discretionary standard of review. The court also ruled the district court improperly construed the insurance contract.
- Seitz v. Metropolitan Life Insur. Co., 433 F.3d 647 (8th Cir. 2006). ERISA claim – The Court of Appeals overturned the district court ruling for the insurer and ruled that even if the claimant can perform some job duties, he qualifies for disability benefits if he cannot perform all job duties.
- Ruttenberg v. U.S. Life, 413 F.3d 652 (7th Cir. 2005). ERISA claim – The Court of Appeals overturned benefit denial and established the doctrine of contra proferentem and “reasonable expectations of the insured” in benefit claims brought under ERISA.
- Herzberger v. Standard Insurance Company, 205 F.3d 327 (7th Cir. 2000). ERISA claim—court overturned prior precedent to issue sweeping ruling modifying standard of review applicable in employee benefit cases.
- Ladd v. ITT Corp., 148 F.3d 753 (7th Cir. 1998). ERISA Claim – Summary judgment for defendant reversed on appeal based on inconsistency between the position taken by the insurer for Social Security disability payments; and benefits awarded to the plaintiff.
Our website, within the Resources section, also contains a wealth of information about the issues that arise in cases relating to disability, life, and health insurance, which includes articles our lawyers have published in leading journals, lectures our lawyers have presented at seminars around the country, articles in major national publications such as the Washington Post and others which our lawyers have been quoted, and Congressional and other testimony presented by our lawyers.
3. Review Client Testimonials
Client testimonials offer insights into a lawyer’s competence and client interactions. Pay attention to keywords reflecting responsiveness, empathy, and understanding. These qualities are crucial in navigating the legal process effectively.
Our firm’s testimonials underscore our commitment to our client’s needs and satisfaction such as the following:
“Thankful for all of your help in this appeal process .. and hopeful that other long COVID clients have the same result.”
“Impressed and encouraged by an excellent appeal by Mark DeBofsky – succinctly, effectively and efficiently presented, researched and argued.”
“Mark and his team repeatedly exhibited a dedicated, ethical, caring attitude and a deep level of expertise that is uncommon”
“The best thing I ever did was contact DeBofsky Law. I cannot speak highly enough of everyone at this Firm. From the beginning I was treated respectfully, answers to questions were answered almost immediately, and most important of all, they listen to you. …”
“The kindness, respect and professionalism afforded to me from my first meeting … up to the Appeal letter by Martina is a model of how people should be treated.”
“Marie singled handedly changed my life. She is an exemplary attorney with Integrity!”
“I was amazingly fortunate to have found Attorney Marie Casciari and her team at DeBofsky Law”
“You made a hard time a lot better.”
“Mark DeBofsky is an outstanding attorney”
“Mark DeBofsky is extremely knowledgeable and caring and doesn’t leave stones unturned.”
4. Competence and Experience Over Proximity: Consider a National Practice
While some lawyers operate nationally, thanks to technological advancements, location matters less than competence. Focus on securing the right lawyer for your case rather than proximity.
We have even successfully represented clients in Europe and Asia who had worked for American companies.
5. Clarify Fee Structure
Understanding how you’ll be charged is vital. Ensure transparency in fee arrangements and ascertain that charges align with the services provided. While low fees might be appealing, prioritize quality representation over cost.
Our firm prides itself on transparent fee structures and fulfilling our commitments to clients.
Learn more about how DeBofsky Law structures fees for ERISA and employee benefit cases.
Related Article: What to Expect When Hiring a Lawyer for a Disability Insurance Claim
Frequently Asked Questions About Choosing an ERISA Attorney
What should I look for in an ERISA disability attorney?
DeBofsky Law advises clients to prioritize three things: practice concentration, track record, and ERISA-specific experience. A general practitioner or Social Security disability attorney may not have the depth required for an ERISA benefit dispute. Look for a firm that focuses on employee benefit claims. The firm should be able to point to appellate court decisions in cases similar to yours. Experience at the appeal stage matters as much as litigation experience. A weak appeal can limit your options in court.
Do I need a local attorney for an ERISA disability appeal?
No. ERISA is federal law, and DeBofsky Law represents clients nationwide. The firm has handled cases in federal courts across the country. DeBofsky Law has also represented clients in other countries who worked for American employers. What matters is the attorney’s knowledge of ERISA and experience with your type of claim, not geographic proximity.
What questions should I ask before hiring an ERISA attorney?
DeBofsky Law recommends asking: Does the firm focus on ERISA and employee benefit claims? Has the firm handled cases involving your specific claim type? What is the firm’s approach to building the appeal record? How are fees structured? Can the attorney explain the ERISA appeal process and likely timeline? The answers help you gauge the firm’s depth. For details visit DeBofsky Law’s fees for more information.
How do I evaluate an ERISA lawyer’s experience?
DeBofsky Law suggests looking beyond marketing and internet rankings. Read the attorney’s biography to learn about the cases they have litigated. Check whether the attorney has published in legal journals, presented at seminars, or taught law students. These types of things are indicators of their expertise. Review client testimonials for patterns of responsiveness, empathy, and results. A strong record of appellate decisions is another reliable measure of depth.
Making the Right Decision
In summary, in complex cases involving benefit denials, selecting the right attorney is paramount. Investing time in finding a lawyer with the requisite skills, experience, and compassion to fight an unwarranted benefit denial yields better outcomes. Therefore, avoid hasty decisions based solely on internet rankings or marketing gimmicks, as the right lawyer can make a significant difference in your case’s outcome.
