If your employer’s insurance plan has denied your disability claim, your head is likely spinning with confusion. While ERISA disability claims regulations are designed to ensure that your needs are met, they can be very complex and make it difficult to obtain the insurance that you need and deserve.
The Employee Retirement Income Security Act of 1974 was a piece of landmark legislation passed with the goal of protecting the benefits of workers in the USA.
Since passed, there have been new ERISA regulations for disability claims and appeals added throughout the years. While the landscape of ERISA laws continues to evolve, the needs of individuals filing disability claims tend to remain the same.
ERISA disability lawyer Claudeth Henry is a trusted source of legal representation and would like to offer some information to those who are struggling with what to do next when their benefits claims have been denied.
To file a lawsuit contesting the decision of your disability claim, you must first file an internal appeal with your insurance company. While this is a necessary step to comply with ERISA disability claims procedures, it is important to keep in mind that you are filing a direct appeal to the source of your initial denial. Your expectations should reflect the nature of this situation, especially as it is not often the case that the insurer will provide a fair review of your claim.
When preparing to file an appeal, it is important to obtain a copy of your complete long-term disability plan. These plans are generally provided to you by your employer at the time you enroll for benefits, so you can request a duplicate if you do not already have one.
This can be easily accomplished by sending a written request. You may need to send this request to your employer or the insurance company, depending on who the plan administrator is. When making the request, be certain to include that you are not asking for a summary of your insurance policy, but for the disability plan in particular.
In the disability plan, there will be a specific section wherein the details of your plan are laid out. This will include all the necessary information and legal terminology which dictate the terms of your policy.
Finally, it is important to speak with an ERISA attorney who can expertly guide you through all the terms of your plan and advise you on the best routes to take to achieve a favorable outcome.
An important thing to keep in mind is that ERISA rules for long-term disability benefits claims are different than the rules for a disability claim filed through the Social Security Administration.
Because insurance companies and the SSA do not always agree on what the term “disabled” means when it comes to eligibility, you may have even been approved for a claim under social security when your employer’s insurance-based claim was denied.
As with any claim denial, it is important to retain a copy of your disability plan from your employer or insurance company as soon as possible. In this disability plan, you will be able to find the language that specifically describes the definition of disability under your plan.
This is especially important with long-term disability cases, as in many situations the disability plan recognizes a new definition of disability after 24 months. In some cases, people are approved for long-term disability and then are astonished to learn that they will no longer receive payments after these 24 months, due to the reasons just mentioned.
While it may be in your best interest to speak with an attorney at the outset of your claim, consulting with an ERISA long-term disability lawyer at any point in your claim can give you the confidence to know what to expect.
ERISA disability lawsuit settlements are the result of nearly 95% of all cases. While there may be a reason for you a person to pursue a court decision on these matters, it is often the best-case scenario for these cases to be handled through settlement and mediation.
If you appeal your case and are still in a position where you are being denied benefits, seeking out a settlement can provide you with an opportunity to access the financial freedom that you need to take steps toward your future.
These cases vary greatly from situation to situation, and it can be so difficult to understand all the complexities involved in ERISA law and the plans that it governs. If you are curious about what the settlement process may look like for you, consider speaking to an ERISA disability lawyer who will be able to guide you through the process, negotiate on your behalf, and advocate for your needs.