Employers often offer their employees several benefits to make their jobs more lucrative. One of these benefits is commonly disability insurance. Short and long term disability insurance can generally be used if you become ill or injured and are unable to work for a long or indefinite period of time.
However, applying for disability benefits and getting approval for them can be difficult without an accomplished ERISA attorney’s assistance. In fact, the Office of Retirement and Disability Policy reports that approximately 53 percent of disability claims are denied each year. If you were among more than half of disability applicants who were denied benefits, you may be able to remedy your situation with help from a Texas ERISA disability appeals lawyer.
The Employee Retirement Income Security Act (ERISA) is a federal law that governs group insurance policies, claims, and appeals. Enacted in 1974, this law covers most voluntarily established pension and insurance plans in the private sector and was created to provide protection for plan participants.
ERISA also grants participants a grievance and appeals process if they feel they were wrongly denied. Many times, however, these appeals are unsuccessful. However, an ERISA disability appeals lawyer in Texas may be able to help disability insurance claimants win their appeal.
The appeals process under ERISA has strict requirements. If these requirements are not followed, the insured may lose their right to an appeal, and therefore lose their chances of receiving disability benefits altogether. Once the claimant has received notification that their claim was denied, they are given 180 days to file an appeal per 29 C.F.R. § 2560.503-1 (h)(3)(i).
Once a claimant submits their appeal, the insurance company must make a determination within 45 days of its receipt. In some cases, the insurance company may request an additional 45 days to make their determination, but they must give the applicant an explanation as to why the extension is needed and the estimated date that a decision will be given. Some plans may also allow for a second appeal if the first one is denied.
In order to move forward with litigation, insured parties seeking ERISA disability benefits historically had to file at least one appeal. However, for claims that are filed after January 1, 2018, the law has recently changed. This new law states that a claimant can file a lawsuit once their claim is “deemed denied”—in other words, when they determine their plan has not complied with the applicable regulations.
While every claimant has the right to an appeal under federal ERISA law, the appeals process can be complicated and burdensome. Additionally, the majority of appeals are not successful. However, a Texas ERISA disability appeals lawyer may be able to increase your chances of a successful appeal.
Our insurance attorneys are well-versed in the ERISA disability claims and appeals process and could work to make sure that all of the steps to an appeal are followed correctly. Call today to find out how we could help in the appeals process for your ERISA disability claim.
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