ERISA creates specific procedures that insurance companies are required to follow whenever a person makes a claim, and furthermore limits access for workers to federal courts. However, long before you need to think about these provisions in the law, you must first file a claim with your insurance company.
Every insurance company in Louisiana maintains their own specialized procedures regarding applications for ERISA benefits. Still, there are some common factors that you can look for to potentially give yourself an advantage in the ERISA disability application process in Louisiana.
Every insurance company has their own procedures to file a claim. However, ERISA requires these insurance companies to provide their customers with a Summary Plan Description, or SPD. The SPD provides information about what benefits the plan provides, as well as how a potential recipient could file a claim for those benefits.
In general, an application for benefits will ask for information concerning:
A successful application should state that the injury or illness did not occur while at work, as that scenario would make it a workers’ compensation claim. It should also state that the condition has been ongoing for a number of months and is expected to last for many months into the future. All this information must be verified by a licensed doctor or therapist.
All long term disability plans have a built-in waiting period for people wishing to make a claim. This waiting period is designed to filter out conditions that result in a quick recovery. This waiting period varies on a plan by plan basis, but generally lasts for around three to six months.
A potential applicant cannot file a claim during this time, but they should be visiting with their doctor to receive treatment and obtain that doctor’s professional opinion as to the extent of the condition. Many people are protected by short-term disability plans that can provide income during this waiting period. Potential applicants should consult with their plan’s SPD to identify the proper waiting period.
ERISA strictly controls when an insurance company must make a decision after a worker files a claim. The law states that most claims must be decided within 45 days after receipt by the insurance company. In special situations, the company can apply for a 30-day extension.
After this time passes, the insurance company must either begin to issue benefits or provide the worker with a detailed letter explaining the reason for the denial. This letter should also contain instructions on how to file an appeal.
Anyone who wishes to take advantage of their employer’s long term disability program must follow strict rules. These rules are in place to prevent fraudulent claims and to ensure that insurance companies have all the information they need to make informed decisions.
This process includes making doctor visits, gathering relevant information, and filing the application after completing a waiting period. An attorney could help you understand the ERISA disability application process in Louisiana. They could also assist if you already filed an application and received a denial. Call today to see what options may be available to you.
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