What are my options after a long-term disability claim is denied?

Long-term disability insurance is supposed to be your safety net. If something happens and you can no longer work, you expect an employer-offered plan to be there.

Because of this, having an insurance company deny your disability claim can be devastating. It does not mean you’re completely out of luck, however. There are ways to appeal a denial.

ERISA and internal appeals

Most long-term disability plans offered through an employer are governed by the Employee Retirement Income Security Act of 1974, often referred to simply as ERISA. ERISA lays out guidelines that employer-offered benefits must follow.

According to the law, an insurance provider must not only have an internal appeals process set up, but also explain the process within the plan summary. Generally, this includes sending a notice of a denial, making it clear how you can appeal, providing relevant documents upon request and offering an explanation for why a claim was denied

A denied claimant must go through the internal appeals process laid out in the plan before filing a lawsuit. It is a complex process, one that requires paying attention and providing information within very specific time periods. Even one small misstep can cause the entire appeal to crumble.

Filing a lawsuit

If you have exhausted the internal appeals process and still believe the insurance company wrongfully denied your claim, you can consider filing a lawsuit. ERISA-related lawsuits go through federal court, where a judge will oversee the case.

The lawsuit might require evidence such as:

  • Medical records
  • Expert testimony
  • Relevant research and reports
  • Your own testimony
  • Documentation from the claims process

ERISA is a complex law, and while it offers protections for workers it can at times seem like it is favoring insurance companies. Having an attorney, especially one with qualities that can help improve the odds of your case, might be beneficial not just if you’re considering a lawsuit, but during the internal appeals stage as well.

When it is your safety net at stake, it is often best not to take any chances.

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