The intention of the Employee Retirement Income Security Act (ERISA) is to protect employees who work for private companies and get their health insurance and 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 health and benefit plans.
Individuals may apply for ERISA claims for many different reasons. Two of these include:
- Rejected short-term or long-term disability benefits
- Rejected life insurance due to insurance company or employer’s policies
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 their employers instead. The best thing to do after denial is to file for an appeal.
How to improve chances of approval
Whether you’re in the beginning stages of applying for an ERISA claim or you’re appealing a denial, these tips might help to better your chances.
- Make sure you meet the requirements to file an ERISA claim or appeal a denied claim
- Provide detailed and accurate information
- Depending on your situation, you may need to provide medical documents for support
- 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 other forms you need to fill out besides the ones provided by the insurance company
- Research any state guidelines alongside the ERISA federal guidelines
- Follow instructions from your doctor and meet application or other deadlines
The process of filing and waiting for an ERISA claim approval isn’t easy. Especially since it’s done privately versus you getting the chance to defend your claim on the stand. It can be discouraging to know that some insurance companies will extreme lengths to get cases denied. However, it is beneficial to remain optimistic.