Workers in private industries benefit from the protections of the Employee Retirement Income Security Act (ERISA). This federal law sets specific standards for various aspects of health plans and pension plans. When it comes to long-term disability (LTD) benefits, ERISA governs the appeal process for denied claims.
If an LTD claim is denied, the plan must provide a written explanation of the denial, referencing the specific plan rules on which the decision was based. This notification also outlines the process for filing an appeal and provides important information about the process.
Comprehensive documentation
The appeal is often the last chance the employee has to provide proof of their disability and the way it impacts their ability to work and live life. Some evidence that might be submitted includes medical records, doctor’s statements and similar documentation. Providing comprehensive information could give the appeal board the ability to make an appropriate decision.
Deadlines are crucial
ERISA imposes strict deadlines for filing appeals. Missing these deadlines can result in the loss of the right to further appeal and potentially the right to litigate the matter in court. An appeal must be submitted swiftly. This is usually 180 days from the receipt of the denial notice. After the appeal is submitted, the plan has a specific timeframe to decide, typically 45 days, with a possible 45-day extension.
Legal representation
Given the complexities of ERISA appeals and the potential for litigation if an appeal is denied, seeking legal representation can be beneficial. A legal representative can navigate the legal intricacies of a case, help prepare a comprehensive appeal and advocate on the claimant’s behalf. Our firm is ready to help anyone in this position, so give us a call today to learn more.