Filing a long-term disability claim due to rheumatoid arthritis

Many people who don’t have rheumatoid arthritis struggle to understand the impact it can have on a person’s life. It’s not just aching joints – an autoimmune disease, it can lead to joint deformity, weight loss, difficulty moving and fatigue.

All of these symptoms can significantly impact your ability to work. But what if you apply for long-term disability benefits through your employer-offered plan, only to be denied? What options do you have?

Understanding ERISA and long-term disability insurance

In order to explain possible next steps, it’s important to understand ERISA, shorthand for the Employee Retirement Income Security Act of 1974. ERISA sets minimum standards for a number of employer-offered health benefits, including long-term disability insurance. ERISA guidelines do not apply to plans offered by churches or government entities, nor to privately purchased plans.

In addition to requiring insurance companies send specific information to plan participants, ERISA can also dictate the appeals process.

How ERISA applies to rheumatoid arthritis and disability claims

Because the term “arthritis” is used a lot, many people – including insurers – underestimate the severity and impact of rheumatoid arthritis, including how it can affect your life. Because of this, an insurer may deny your long-term disability claim.

If that happens and you want to appeal, you generally have to first go through all the internal appeals processes outlined as part of the coverage. It’s important during this step to document everything and hit all prescribed deadlines.

Only after the internal appeals process is exhausted can you consider filing a lawsuit against the insurance company, arguing it incorrectly denied benefits. If you take that route, the lawsuit goes through federal court where a judge will look at the case.

ERISA-related lawsuits can be incredibly complicated, offering little room for error. It is why many people hire an attorney to help guide them through the process. This type of decision can be even more important if a health condition, such as rheumatoid arthritis, is widely misunderstood or underestimated.

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