The intention of the Employee Retirement Income Security Act (ERISA) is to protect employees who work for private companies and receive benefits from their employers versus their own personal insurance company.
Prior to this act, each state had their own regulations regarding employee benefits, so ERISA serves to encompass all the rules and regulations into one, making it easier to protect employees.
Why apply in the first place?
Although many amendments have been made to ERISA’s overall regulations, such as the Consolidated Omnibus Reconciliation Act (COBRA), which reimburses employees after job loss or other related events, private employees still face hardships when it’s time to rely on ERISA’s benefit plans.
Individuals may apply for ERISA claims for many different reasons. Two of these include:
- Short-term or long-term disability benefits;
- Life insurance due to insurance company or employer’s interpretation of the policy.
What to do after a denial?
Rejection for ERISA cases are more likely due to the difficulty of the entire process. This is because insurance companies tend to take advantage of ERISA claimants, leaving them with little or no benefits at all.
While ERISA is supposed to protect employees, it ends up protecting the insurance companies instead. The best thing to do after denial is to submit an appeal.
How to improve chances of approval
Whether you’re in the appealing a denial or a termination, these tips might help to better your chances.
- Provide detailed and accurate information
- Provide medical documentation supporting your disability
- Provide documents from both your work and your medical provider
- Be consistent with the information you provide, or the insurance company will use it against you
- Find out what forms you need to fill out
- Follow instructions from your doctor and meet application or other deadlines
The process of waiting for an ERISA appeal to be granted isn’t easy. It can be discouraging to know that some insurance companies misconstrue the facts to get cases denied.