ERISA is a federal law that provides employees with various protections of their long term disability benefits. These benefits are highly important and if a person is unable to work for an extended period, their long term disability benefits should provide them with a portion of their salary (usually 50 to 80 percent) until they are able to return to work.
ERISA long term disability usually begins to kick in after short-term disability runs out, but unfortunately, insurers do have the right to deny a claim for long term disability. This can be frustrating to claimants, who need their benefits to survive. To understand how to avoid this or fight a denial it may be important to understand the common reasons for ERISA long term disability insurance denial.
A policy-carrier can deny a long term disability claim for a variety of reasons, but one of the most common reasons for ERISA long term disability insurance denial is insufficient medical evidence. During the claims process, injured and ill workers will need to submit documents from a medical professional to prove they are actually unable to work. Unfortunately, this does not always work and even with medical documentation an insurer can deny a claim.
Many insurers have their own team of doctors, nurses, and other medical professionals they consult with before deciding on a claim. These medical professionals do not have any actual interaction with the claimant and, since they work for the insurance company, they have a vested interest in denying the claim.
The claims process is complex and fully understanding it is nearly impossible without a legal background. Unfortunately, insurers are aware of this and often use the complexity to their advantage. Since even the smallest mistake can disqualify a person and cause them to lose benefits, it is necessary for claimants to file properly and in a timely manner.
Insurance companies can also deny a claim if they do not receive the right materials. Claimants are responsible for submitting multiple documents to the insurance company and these documents are often lost or misplaced by personnel, which can also lead to a denial. To ensure they receive the benefits they are entitled to, many policyholders work with an attorney who can help them through the application process.
A claim denial can be angering and emotionally devastating. However, claimants do have the right to file an appeal, and if they do not agree with the outcome of the appeal, have a right to take legal action against the carrier of the policy. During an appeal, a lawyer may be able to help by:
Fighting back against a large company is always hard, but with help from an attorney, it may be possible for a claimant to prove their case and get the benefits they need.
There are numerous common reasons for ERISA long term disability insurance denial and they all prevent honest people from accessing the benefits they need to thrive and recover. Despite the high number of denials issued by insurers, it is possible to fight back after a denial.
Call an attorney to learn how. A compassionate attorney can help you thoroughly review your claim to either avoid a denial or help to understand the reasons behind a denial. Call to set up a free consultation.
Following graduation from Loyola Law School in New Orleans in 1990, Price McNamara served as a Federal Judicial Law Clerk to the Honorable John M Shaw, Chief Judge, United States District Court Western District of Louisiana.
Mr. McNamara founded the Law Offices of J. Price McNamara, and began putting his past experience to work for the injured and disabled clients he now represents against the insurance companies in personal injury and long term disability and other insurance disputes in both federal and state courts