Labor and Employment Law

Consultation with a lawyer is always recommended whenever dealing with the legal system. Benefit claims through employment, such as long-term disability insurance benefits, are governed by a federal law commonly referred to as ERISA law. The success of New York ERISA law claims is dependant on the insurance or other forms completed when applying for benefits. Introduction of evidence during the court proceedings may not be productive in supporting a claim. An attorney specializing in New York disability laws and familiar with ERISA law is an important asset to utilize in providing adequate preparation of the facts needed to prove a disability claim and guarantee receipt of benefits.

(Courtesy of Association of the Bar of the City of New York)

The insurance company will have issued a group policy to the employer, a trust, or some other entity detailing the long-term disability benefits available for an occupation, if available. Employees are entitled by New York disability law to get a detailed summary of the terms of that policy and how the policy is affected by federal ERISA laws. Employee manuals published by the employer may provide information about disability benefits and the proper procedures to apply for them. A request should be made to the employer for two other documents: The “summary plan description” and the “insurance certificate.”

(Courtesy of Association of the Bar of the City of New York)

A doctor’s and employee’s answers are crucial to the success of a disability claim. Many doctors understandably do not appreciate how important their answers may be to the overall success of the claim. In most cases doctors give a brief conclusion – that you are disabled -- without discussing in detail how that conclusion was reached. An application must compare the relevant duties of an occupation with the limitations caused by specific injury or illness. A disability plan should be read very carefully to learn whether the presentation of evidence must declare, with a detailed explanation, how the disability prevents the employee from engaging in that specific occupation or any other occupation. The employee must assist the doctor by providing a detailed statement of the work duties that the employee is no longer able to perform. The physician must explain in detail what the condition is and how it restricts the employee’s ability to perform some or all of the duties described. A separate report should be prepared, rather than just filling in a short space in a form. In summary, the doctor must contrast the specific duties of the occupation in question with the employee’s medical condition to persuade the insurer how the insurance policy’s definition of disability has been met in accordance with New York disability laws.

(Courtesy of Association of the Bar of the City of New York)

This depends on the situation. In New York, an insurance company is entitled to rely on the accuracy of the answers given in an application. In many cases, an insurance policy that has been in effect for more than two years, without modification, will be enforceable even if there are discrepancies on the insurance application. If a spouse died within two years after the insurer issued the policy, in some cases even if the spouse was insured for more than two years, the insurer can “rescind” the policy. This would cancel the policy as if it never existed but only if the spouse husband incorrectly responded to a question and the insurer can prove it would not have issued the policy at the same premium if it had received the correct information. This is concordant with ERISA laws and New York disability laws. It is important to consult with a lawyer to request the insurance company to send copies of the following: The application the spouse filed; the insurance policy or, if it is a group policy, the insurance certificate; and the insurer’s written explanation why it has decided not to pay the benefits. Once these documents are received, discuss the contents with a New York lawyer specializing in employment and insurance law to determine the appropriate next step to take in advancing the claim.

(Courtesy of Association of the Bar of the City of New York)