Guerrini & Thompson, P.C. is a law firm dedicated to providing personal and professional attention to each client and their respective claims. The firm concentrates on claims for ERISA short term and long term disability benefits, individual disability insurance benefits, accidental death and dismemberment benefits, and life insurance benefits. When you call Guerrini & Thompson, P.C., you will not speak to a mere case screener—you will speak to John Thompson, an experienced disability insurance attorney, who will personally evaluate and discuss your options. John handles each claim from beginning to end for clients across the State of Texas. And, unlike out-of-state law firms offering to handle claims in Texas, John lives and practices in Texas and handles only claims in Texas.
HAVE YOUR BENEFITS BEEN DENIED?
If you are reading this because you have been denied your short term or long term disability benefits, you are experiencing one of the most stressful periods in your life.
• You thought that the insurance company would help you when you became disabled, but it has let you down by denying your claim.
• You cannot believe the insurance company that took your premiums for so many years has denied your claim.
• You cannot understand how the insurance company could deny your claim when you have provided all of the information that the insurance company asked for and have provided the opinion of your own doctor that you are disabled.
• You are not able to work. The insurance company will not pay you your benefits, but the bills keep coming in.
• You do not know where to turn for help.
WHO WE ARE
We are an ERISA benefits law firm with extensive experience and we are here to help you with your claim. When you call, you will speak to the attorney, John Thompson, not a mere case screener or paralegal. John will personally visit with you to learn who you are, to identify your medical issues, to understand how you are prevented from working, and to determine how he can help you. He will then develop an appeal strategy that fits your claim and work closely with his staff to implement the strategy.
• He will be personally involved throughout the process.
• He will oversee his staff in gathering the evidence needed.
• He will work with your doctor as needed.
• He will recommend other tests if needed.
• He will work with you to prepare an appeal that will maximize the chances that your claim will eventually be approved.
If your appeal is denied, we will file a lawsuit in the appropriate court, as we have done for numerous clients before you. We will prepare the case for trial and work to maximize its potential settlement value in the process.
WHY YOU NEED A LAWYER
You should have a lawyer assist you with your claim. The insurance companies do this every day, but you have only one claim and, usually, only one appeal. The most critical time when you need a lawyer is during the administrative appeal to the insurance company. The lawyer you hire should be experienced in such matters and know the methods by which the insurance company will deny your claim. And if litigation becomes necessary, you want an attorney who lives in Texas and practices in Texas courts.
WHO SHOULD BE YOUR LAWYER
You should ask any lawyer how long they have been handling such claims, what percentage of their practice involves long term disability cases, and the approximate number of claims, appeals and lawsuits they have handled. As important, the lawyer you retain should know the courts and judges in the area, so that your case can be filed in the most appropriate court.
OUR EXPERIENCE
Since 2000, Guerrini & Thompson, P.C. has been dedicated to helping individuals across Texas recover ERISA short term and long term disability benefits, individual disability insurance benefits, and life insurance benefits.
John Thompson has extensive experience in ERISA and other insurance benefit matters. He has been licensed to practice law in Texas since 1997. In 2016, with 19 years experience litigating complex business disputes and insurance matters, he decided to concentrate his efforts on primarily handling ERISA short term and long term disability benefit matters for individuals in need. He has been zealously helping his clients throughout Texas recover their benefits ever since.
Bernard Guerrini (now retired) developed a wealth of knowledge and experience handling ERISA long term disability claims. Bernie was licensed to practice law in Texas in 1978 and practiced for 45 years before retiring in August 2023. For the 23 years leading up to his retirement, Bernie focused almost exclusively on handling ERISA short term and long term disability benefit cases.
WHAT WE DO
• personally evaluate your medical records and develop an appeal strategy;
• work with your doctors to bring forth the evidence needed to substantiate your appeal;
• recommend other exams and tests that may be needed to explain certain aspects of your disabling condition;
• file your lawsuit in the appropriate court, if it becomes necessary; and
• appeal your case to the Fifth Circuit Court of Appeals, if appropriate.
SHORT & LONG TERM DISABILITY BENEFITS
Employer-provided disability insurance benefits, which are governed by the Employee Retirement Income Security Act of 1974 (ERISA), pay a portion of a claimant’s earnings if they cannot work because of illness or injury. Typically, the first six months of disability insurance benefits are paid by what is referred to as short term disability (STD) insurance. Typically, the benefits paid thereafter, until Social Security Retirement Age, are paid by long term disability (LTD) insurance.
The ERISA claim regulations apply to both STD and LTD insurance benefits. While STD insurance and LTD insurance pay benefits, the terms under which such benefits are paid and calculated differ significantly.
The definition of disability is usually the same for both STD and LTD insurance benefits. Some of the differences between STD and LTD benefits, in addition to the duration of the benefits, are very significant. STD insurance benefits may be calculated based on 100% of the claimant’s weekly earnings with no offsets. LTD benefits are typically 60% of the claimant’s monthly earnings offset by numerous sources of other income, most notably, Social Security benefits. The LTD definition of disability changes at a point, typically 24 months, from claimant's "own occupation" as the criterion to "any occupation" the claimant can perform based on education, training and experience. So the promise to pay 60%, if you cannot do your job, is not necessarily the most accurate way to state the benefit amount or the obligation.
The STD insurance benefits claim may or may not be subject to a pre-existing condition clause. The LTD insurance benefits claim is always subject to a pre-existing condition clause which may be avoided in certain circumstances.
The LTD insurance benefits are subject to more defenses to the obligation to pay than STD insurance benefits. One such defense is the limitation of benefits to 24 months for disability based on a mental or nervous condition and/or alcohol/drug abuse. Some insurance policies also have a similar limitation for subjective symptoms which cause disability.
CLAIM PROCEDURE
Both STD and LTD insurance benefit claims are started with a notice of claim that must be given within a certain period of time that is stated in the insurance policy. Typically, the process of providing notice of claim starts with an inquiry to the human resources department. The claimant should be provided with a three-part form or with a web address to file the claim. On the form, one part is filled out by the employer, one part by the claimant’s doctor and one part by the claimant. This form is sent to the insurance company. Within a specified period, the insurance company should contact the claimant for the continuation of the claim process. If the insurance company does not contact the claimant, the claimant has an obligation to provide additional information required by the policy.
Once a claim is made, the insurance company has a certain period of time to make a decision. Special circumstances allow the insurance company to obtain an extension of time. If the insurance company determines to pay the benefits, it will issue monthly checks for the STD or LTD benefit in the amount calculated according to the terms of the policy.
If the insurance company determines that it will not pay the benefits, it must issue a denial letter with the items required by the ERISA regulations. The denial letter, among other things, must advise the claimant that the claimant has 180 days to appeal the denial determination and identify the information necessary to perfect the appeal. The additional information typically includes office visit notes, doctor letters, tests and/or films.
Once the appeal is filed, the insurance company has a specified period of time and extensions to make a determination. It may reverse its decision and start to pay benefits. It may uphold its decision to not pay benefits. Some insurance companies allow for a second appeal which is governed by the same regulations for the first appeal.
LAWSUIT PROCEDURE
If the claimant is not willing to accept the adverse benefit determination, then the claimant must file suit. This suit is generally filed in a federal court. The case is presented to the judge without a jury and is limited to the evidence in the administrative record with respect to the merits of the claims. Historically, most cases in Texas were decided on the basis of whether the insurance company abused its discretion in denying benefits; with judges sometimes considering an insurance company's inherent conflict of interest (i.e. profiting by denying claims). Since 2018, judge's are more frequently reviewing claims de novo, which results in the judge independently reviewing the record without deference to the insurance company's determination. Which review standard the judge will apply--abuse of discretion or de novo--will depend on the specific benefit plan/policy at issue.
TIME INVOLVED IN A BENEFIT CLAIM
The time involved in an ERISA STD or LTD insurance benefit claim can be substantial and will tax the financial endurance of any claimant. From the date a claim is filed, it may take the insurance company 90 days to make a determination, the claimant may take 180 days to file an appeal, the insurance company may take 90 days to reach a decision, if necessary, suit is filed with a trial date of 13-15 months, a decision by the judge may take 6 months, an appeal to the court of appeals adds 18 to 24 months. The entire process may total 3-4 years, or longer.
TAXABILITY OF BENEFITS
Taxability of the benefits depends on whether the claimant paid the disability insurance premium with after-tax dollars. If so, typically the benefits would not be taxable. On the other hand, if the employer or the claimant paid the premiums with before-tax dollars, typically the benefits would be taxable.
