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3 things applicants need to know about ERISA appeals

On Behalf of | Nov 3, 2023 | Erisa

For decades now, the Employee Retirement Income Security Act of 1974 (ERISA) has provided key protections for employees who receive certain types of workplace benefits. By regulating retirement and pension benefits, as well as certain kinds of specialty insurance coverage, ERISA protects workers from scenarios in which they might otherwise face unfair financial hardship and violations of their broader rights.

Workers whose benefits packages include private disability coverage often count on that insurance when experiencing a personal medical emergency. Occasionally, those who need to make use of specialty insurance coverage end up facing challenges along the way. They may have to appeal an unfavorable decision about short-term or long-term disability coverage by their employer. There are three important facts that people should know about ERISA appeals.

The law guarantees the right to appeal

ERISA requires that insurance companies make decisions in the best interests of policyholders, but that isn’t always what happens. Leaving the final decision with the insurance company without any form of recourse would be unfair for policyholders largely dependent on benefits for their financial stability. Therefore, ERISA protects against unfair determinations by protecting the right to appeal a decision related to ERISA-governed benefits in law. Any worker denied coverage in what they feel is a wrongful decision can potentially appeal within 180 days of the unfavorable decision to get the benefits they deserve.

Only one appeal is possible

Certain benefits programs, like Social Security Disability Insurance (SSDI) benefits, have multiple different layers of appeal available. That is not the case for ERISA-governed disability benefits. Workers have one appeal, and after that, their only option may be to take the matter to civil court.

Evidence submitted in an appeal can help in court

Those who need to ask for intervention from the Civil courts regarding an unfavorable benefits determination need to carefully present evidence during the appeals process. What they present during an appeal will largely determine what they can use as evidence during the court process. It is, therefore, of the utmost importance that ERISA appellants have the right guidance throughout the process. Otherwise, they may fail to submit adequate evidence and may have a hard time prevailing if they must take the matter to civil court.

Learning more about the rules that apply during an ERISA appeal can make a major difference for those in need of benefits when they are no longer able to work. Seeking legal guidance is a good way to get started.