The federal Employee Retirement Income Security Act (ERISA) is in place to protect employees’ rights to receive disability benefits from private employers when they need them the most. But long-term disability claims are consistently denied by insurers for several reasons.
If an insurer rejects your claim, next comes the appeals process and potentially filing a lawsuit against the insurer if your appeal fails. The process can be confusing and frustrating, especially for employees unable to work due to an injury or illness. Here are some frequent questions about the process.
Does ERISA cover my employer’s disability plan?
ERISA protections apply only to private, voluntary, self-funded disability insurance the company provides. Most employer-sponsored plans are included. Check by reviewing the Summary Plan Description booklet from your employer. If you can’t locate it, check with your human resources representative, benefits plan administrator or employer.
What is covered under ERISA?
The policy summary outlines what is covered if you cannot work due to an injury or illness. A wide variety of physical and mental disorders and conditions may be covered, including cancer, neurological disorders, chronic illnesses, anxiety and depression. Some workplace injuries may be covered, but nearly all ERISA disability claims are unrelated to employment.
Can I appeal a denied claim?
Yes. Insurers routinely deny claims for assorted reasons, including paperwork errors, inadequate medical documentation, exclusions or even something you missed in the fine print. But you don’t have to accept the insurer’s decision, which must be in writing. You have 180 days from the date of the written denial to ask for an administrative appeal. The insurance company must outline the process in the paperwork you receive from them.
What if my appeal is rejected?
If the insurer denies your appeal, it may be time to take legal action. ERISA-related lawsuits are decided in U.S. District Court. Your attorney can seek damages that include disability benefits, payments for pasts benefits owed to you and legal costs.
Like many others, you have worked hard to earn a living and expect your employer’s insurance company to live up to their promises if you are unable to work due to an illness or condition covered under your disability plan. To ensure that the process goes as smoothly as possible, it’s best to consult with an experienced ERISA attorney before filing a claim.