Private insurance companies administer most employer-provided long-term disability (LTD) plans. Insurers also meticulously review LTD claims because benefits are usually expensive. And, they routinely deny claims for many reasons, such as missed deadlines or paperwork errors.
But workers with rejected claims under employer LTD plans have specific rights to appeal thanks to the Employee Retirement Income Security Act of 1974 (ERISA). The law was established to ensure that American workers are treated fairly in the administration of employer-provided benefits.
Insurers must be transparent
LTD plans usually differ from employer to employer in the types of conditions and injuries they cover. Many employees are unaware of what the benefits entail until they can no longer work due to a debilitating condition. If the plan covers their illness or injury, they must follow the rules for filing a claim.
Insurance companies have a reputation for using fine print and confusing language when communicating with policyholders. However, under ERISA provisions, insurers must provide written notice clearly explaining why your claim was denied. They must also inform you of your right to have the claim reviewed, allowing you to supply the information necessary to challenge their decision.
You also have the right to appeal
ERISA mandates that insurers comply with federal rules and maintain comprehensive records to show they acted appropriately. Appeals often result when insurers stray from those guidelines. Since insurance policies and ERISA guidelines can be complicated, the help of an experienced attorney specializing in LTD denials and ERISA rules increases the chances of filing a successful appeal.