Denial or termination.
Those words will have an obviously chilling effect on you if they are delivered by an insurance company in a health matter related to a long-term disability. Insurers’ attempts to undercut the lawful benefits or compensation owed claimants understandably have a potentially devastating impact on the lives of those policyholders and their families.
Strategies powered by the goal of avoiding contractual responsibility may be frightful. That hardly means, though, that they are bullet-proof against disabled individuals whose health care is covered through and administered by the federal Employee Retirement Income Security Act.
We duly note ERISA’s protective umbrella at the established national pro-claimant ERISA Law Center. We stress on our website that the legislation “protects those who need to earn or keep their disability benefits from their employer.”
That protection comes via comprehensively set forth provisions spotlighting the standards, processes and time limits applicable to a claim challenge. The law works, but we duly note as well that its successful application “does not mean that using it for your benefit is easy.”
In fact, many claimants are surprised and even overwhelmed by just how complex and detailed ERISA mandates can be.
Here’s an instructive example. Many individuals seeking to challenge a revocation or denial might reasonably think that they can retain legal counsel and take their grievance straight to court. That in fact doesn’t happen. The ERISA process first requires that a claim be dealt with internally, and in a time-sensitive way.
Moreover, a denial sought to be challenged must also be pursued and ruled upon administratively in the first instance, and again in a time-is-of-the-essence manner. An ERISA appeal is a complex undertaking, and claimants need to take great care in record compilation and linked matters at that stage.
Recourse to a court of law might ultimately be pursued to challenge a denial, but only after all internal processing requirements have been complied with.
We will spotlight relevant details concerning the ERISA claims process in our next blog post.