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1. The use of discretionary clauses creates an uneven playing field for consumers who want to challenge an insurance company's decision in court.

2. Disability insurance provides critical income support for many consumers who would otherwise lose their income because of an injury or illness.

3. This income support may allow consumers to pay for COBRA or other health insurance coverage.

4. Health insurance coverage for people with disabilities is critical in order to receive medical attention that may help them return to leading active and productive lives.

5. People with disabilities who do not have access to disability insurance are unlikely to have easy access to health coverage through the safety net (Medicaid and Medicare).


Many times we will receive cases where another attorney has handled the claim's appeal before we become involved. If anything can be said as a generalization, most of the attorneys unfamiliar with ERISA are ineffective. The scope of review by the reviewing court is limited to the matters that were presented to the insurance company and/or claims administrators prior to filing suit. Wilkins v. Baptist Healthcare System, 150 F. 3d. 609 (6th Cir. 1998). ERISA cases are harder than other cases. ERISA decisions permit discretionary clauses in insurance contracts that give legal deference to the insurer's decision unless the claimant can prove that the insurer's decision was unreasonable or irrational (the "arbitrary and capricious" standard), which is a very difficult standard to meet. ERISA Claimants are much less successful in cases where the arbitrary and capricious standard was applied (only 28% were successful), than they were in cases involving "de novo" review (68% were successful). That is why you should call us as soon as possible.