Long-term disability insurance is supposed to be your safety net. If something happens and you can no longer work, you expect your employer-offered plan to be there.
Because of this, having an insurance company deny or terminate your disability benefits can be devastating. But, it does not mean you have no recourse. There are ways to appeal a denial or termination.
ERISA and administrative 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 or termination, making it clear how you can appeal, providing relevant documents upon request and offering an explanation for why a claim was denied or terminated.
A denied claimant must go through the administrative 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. Because of this, and the importance of submitting a thorough appeal, you should consider hiring an experienced ERISA attorney to appeal the denial or termination of your long term disability benefits.
Filing a lawsuit
If you have exhausted the administrative appeals process and still believe the insurance company wrongfully denied or terminated your claim, you can consider filing a lawsuit. ERISA-related lawsuits go through federal court, where a judge will oversee the case.
Under ERISA, normally the only evidence that can be submitted for consideration by the court, is whatever was submitted to the insurance company during the administrative appeals process and why considering hiring an experienced ERISA attorney is highly recommended during the appeals period.
ERISA is a complex law, and while it offers protections for workers, it can, at times, favor 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 administrative appeals stage as well.
When it is your safety net at stake, it is often best not to take any chances.