ERISA Disability Claims and Litigation gives you the specialized knowledge you need to handle the full spectrum of ERISA disability claims. This book significantly supplements and updates its predecessor, An Attorney’s Guide to ERISA Disability Claims, which was written by Mr. Riemer and published by James Publishing in 2014. Like the earlier book, ERISA Disability Claims and Litigation offers extensive information about claims filing and appeals but it greatly expands the earlier volume to include new chapters on:
- Case screening and intake procedures;
- Understanding ERISA disability policies;
- ERISA regulatory requirements;
- Protecting your client’s ongoing benefits; and
- Litigating ERISA disability claims in federal court.
The authors offer valuable insight and tips at each step. The book’s extensive appendix of sample practice forms, templates, and communications makes it easy to apply the authors’ work to your own practice.
ERISA Disability Claims and Litigation also addresses significant changes in the law that occurred since the prior book was published. Specifically, the book provides an overview of the ERISA procedural claims regulations adopted by the United States Department of Labor effective April 1, 2018, along with strategies to maximize these requirements to your client’s advantage and avoid traps set by the insurer.
Filled with practical strategies and helpful templates and forms, this book teaches you how to assemble a compelling case that your client meets the policy’s standard of disability. You will learn:
- Four questions to identify possible long-term disability benefit claims. §1.1.
- How to interpret the eight policy provisions that most often make or break a claim. §§2.0-2.8.
- How to guide your client, your client’s doctor, and your client’s employer to avoid traps when completing the claim application forms. §4.1.
- The importance of adequate medical evidence. §5.1.
- How insurers cherry-pick doctors’ treatment notes and what to do about it. §5.1.4.
- How to evaluate whether the client needs more medical testing. §5.1.4.
- What to include in a Residual Functional Capacity Questionnaire. §5.1.6.
- What to ask a doctor to include in a narrative report. §5.1.7.
- A better alternative to allowing the insurer to interview the claimant’s doctor. §5.1.8.
- How to prep your client for an insurer interview. §5.1.9.
- How to handle a claim when the policy’s occupational standard shifts from “own occupation” to “any occupation.” §5.2.3.
- Information to gather for the client’s affidavit. §7.5.
- What to include in your letter of representation when appealing a denial. §7.1.
- How to get and what to look for in the claim file. §7.1.
- How to analyze the denial letter so that you can respond to all the insurer’s concerns. §7.2.
- When to send your client for a functional capacity evaluation and how to overcome an unfavorable one. §7.4.1.
- What’s required for valid neuropsychological testing. §7.4.2.
- When to get a vocational expert evaluation and what one consists of. §7.4.3.
- How to score a surveillance videotape to refute insurer claims that it shows your client can do his or her job. §7.74.
- 15 Arguments you can make to the insurer for reversing its original denial. §7.9.
- How to determine when to sue, whom to sue, and where to sue. §§10.1.1-10.1.3.
- Strategies for producing a compelling and winning complaint. §10.3.2.
- Causes of action to include in your complaint and remedies to request. §10.3.3.
- Tips for successful settlement discussions. §10.5.3.
- How to get discovery and what to request. §10.6.
- Strategies for winning a summary judgment motion. §§10.7.1, 10.7.2.
- How to make a successful application for attorney fees. §10.9.
ABBREVIATED TABLE OF CONTENTS
CHAPTER 1 How to Screen Cases
CHAPTER 2 How to Understand the Policy
CHAPTER 3 ERISA’s Regulatory Requirements
CHAPTER 4 How to Apply for Benefits
CHAPTER 5 How to Prove Disability
CHAPTER 6 How to Protect Your Client’s Ongoing Benefits
CHAPTER 7 How to Appeal a Denial or Discontinuation
CHAPTER 8 How to Evaluate the Post-Appeal Claim
CHAPTER 9 Additional Appeals
CHAPTER 10 How to Litigate an ERISA Disability Claim
ABOUT THE AUTHOR
Scott M. Riemer and Jennifer L Hess are partners at Riemer Hess LLC, one of the country’s premier ERISA and long-term disability law firms, with headquarters in New York City. Founded more than 25 years ago by Mr. Riemer, the firm has distinguished itself as a national leader in long-term disability claims, appeals, and litigation. The firm also represents individuals in matters relating to long-term care, life insurance, and health insurance.
Scott M. Riemer is a nationally renowned expert on ERISA and disability topics. Mr. Riemer is the author of “An Attorney’s Guide to ERISA Disability Claims,” published by James Publishing in 2014. Mr. Riemer is regularly called upon by the media and his peers within the legal industry to provide his unique insight and perspective. His articles have appeared in the New York Law Journal, The New York Employee Advocate, CFIDS Chronicle, and many other publications. He has been quoted as an ERISA litigation authority in Newsday, Lawyers USA, and Consumers Digest, and has lectured and presented on a variety of topics in forums such as the American Conference Institute, the Pension Rights Center, the American Bar Association, the New York State Bar Association, and the International Lyme and Associated Diseases Society.
Throughout his career, Mr. Riemer has fought to protect and advance the rights of the disabled. He received the Public Education Award from the New York City Chapter of the National Multiple Sclerosis Society for volunteer services and pro bono efforts to make the procedures used for long-term disability insurance more equitable for those with multiple sclerosis. In addition, one of Mr. Riemer’s cases was awarded the Courageous Plaintiff Award by the National Employment Lawyers Association of New York.
Mr. Riemer graduated from the University of Michigan Law School in 1983. He is an attorney in good standing admitted to practice in the State of New York, the Southern District of New York, the Eastern District of New York, the District of Connecticut, the Court of Appeals for the Second Circuit, and the United States Supreme Court.
Jennifer L. Hess has been working to obtain financial security for disabled, ill, and disenfranchised individuals for over 10 years. Ms. Hess joined Mr. Riemer’s practice in 2016 after advocating for approval of Social Security Disability benefits at the administrative level, and later in federal litigations against the Commissioner of Social Security. Ms. Hess’s practice philosophy is one of client empowerment, total transparency, and dependability.
Since joining the firm in 2016, Ms. Hess’s practice has included the full spectrum of long-term disability claims, life insurance matters, administrative appeals, alternative dispute resolution, and claims-level advocacy. Ms. Hess has represented hundreds of clients at the firm – helping to recover and secure over one hundred million dollars in benefits and settlements. Ms. Hess became a partner in 2020.
Ms. Hess is regularly called upon by her peers throughout the country to offer insight with respect to long-term disability and ERISA matters. She regularly serves as primary and local counsel in long-term disability litigations brought in the Southern District of New York and the District Court of Connecticut. In recent years, Ms. Hess has pushed the envelope in expanding the evidence for consideration in ERISA litigations, where the courts often are otherwise limited to the administrative record. In 2018, she presented on a conference panel on how to obtain and conduct ERISA long-term disability trials.
Ms. Hess has written several e-books on long-term disability matters, in addition to having her content published on the websites of non-profit organizations. Her litigation matters often are featured by legal news outlets, including Law 360.
Ms. Hess graduated from St. John’s University School of Law in 2013, where she received an award for dedicating over 100 hours of pro bono service to advocating on behalf of victims of domestic violence. She graduated magna cum laude with a B.A. in Political Science from The State University of New York at Stony Brook. She is an attorney in good standing admitted to practice in the State of New York, the Southern District of New York, the District of Connecticut, and the Court of Appeals for the Second Circuit.
To learn more about the authors and their firm, visit www.riemerhess.com.