I was a police officer 10 years. I had one night after work came home and was eating dinner and went into a major grandma seizure where I fell, broke my back and was hospitalized. This then happened again to me 1 month later, again while at home. I was out of luck as this was not a workers compensation issue given the proof to show it was work related was not a chance per everyone and legal aid I sought. Nonetheless, I made a full recovery in 2015 (after being off work nearly 8 months on light duty). Upon my return to work, I thought I was fine. Others noticed I was not. I developed major neurological issues related to memory, ability to write, time management, being able to focus and more. It got to the point where I was basically forced to retiree as I was not cutting the standards. And this is from a cop that's been doing this since he was 13 as a police explorer and who has won many awards for his hard work, youngest to ever promote in the department etc.
Thankfully, I had paid into a "NON PROFIT DISABILITY COMPANY WHO IS NON ERISA" that fought me from day 1 and did not want to pay me even tho all doctors agreed I was disabled from my "own occupation". I was awarded for 24 month disability pay. The disability company will pay life benefits assuming your "totally disabled" from all jobs after 24 months.
My doctors to this date have documentation and call my issue a neurological disorder have put me totally disabled for the purpose of the company accepting my claim because my doctors no i'm NOT fit to be working with my issues. Its's now been 24 months and the NON PROFIT company has wrote me a denial letter indicating it's their belief I can reasonably go back to work and by that, they rule I don't meet the total disability standard of their plan. This is based on their doctor review of my records and based on their administrator doing the review (of course in their favor). However, my doctors who have treated me indicate I am not to work and totally disabled. So who has the burden of proof? WHY hasn't the company ordered me to take a Vocational Assessment?
I looked into paying for a vocational assessment on my own but that's $5000 I don't have. So what other proof is needed for the company to believe me. They don't have to obey ERISA and skated that too by being non profit. What case law supports my case in that weight from my doctors trump the "opinion" of the administrator and their company doctor who has never met me a day in their life.
WHO can prove I am disabled to the plan and how else do I do this. If my own doctors cant persuade the company enough what else do I do. Do I just accept their denial and assume there is no way to get them to overturn this. I don't have money for a legal attorney any longer. This service was being provided to me and the reason I got benefits to begin with. But has the company drags their feet longer, my attorney fees got to the point I can't afford the attorney any longer and I am maxed out financially, and not working cause I cant. Furthermore, social security is not an option for me as police officers don't pay into social security. I had 1 year of state disability but that's exhausted and I am at a place in time without help or anywhere to turn to. I am stuck and this company should be paying. But again who has the burden of proof to establish if I am disabled. I have supplied my proof that shows I am. They can do this too me because they are non erisa and have less restrictive law.
Thank you for your time in reading this long question and any help is much appreciated.
Quick reply - burden of proof, police officer and hospitalization:
The question of who has the burden of proof can often decide the outcome of litigation. What does "Burden of proof" mean in law? In a legal dispute, one party is initially presumed to be correct and gets the benefit of the doubt, while the other side bears the burden of proof. A non-ERISA plan with over 100 participants does not require an annual audit. Unlike most companies, non-profit organizations are exempt from Employee Retirement Income Security Act (ERISA). ERISA was created to protect employees' rights to receive benefits, including disability claims.
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- California Plaintiff Fails to Satisfy Burden of Proof in Long-Term
- Disability Discrimination Law in the California, Explained (2019)
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