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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.
I want to say thanks to J. Price McNamara for the sound free advice he gave me related how to increase my chances of being approved for Long Term Disability of being denied. I must say after implementing elements of his sound advice such as showing the insurance company proof of how my illness/disability had
I needed an attorney with a specific specialty and Price McNamara was definitely the right choice. His representation was based on principles that are probably unsurpassed by any other attorney in the field. McNamara represents individuals, not big-money corporations, like so many others in his field of specialty. He is a consummate professional, extremely knowledgeable
I found Mr. McNamara to be practical and efficient. He did what I needed in a reasonable amount of time, keeping me well informed and with excellent results. He communicated with me clearly and on a timely basis. I will use him in the future.
I am a current client of Mr. McNamara’s. He is very accessible and responds to my emails and phone calls in a timely manner. I find him to be very professional and knowledgeable, as well as ready, willing and able to address all of my questions and/or concerns.
I am an attorney. Price represented me, and in a separate suit represented my daughter, for injuries. He moved the cases at lightning speed and obtained maximum recovery. I was grateful and surprised. I would recommend Price to anyone who wants a top-notch attorney who gets results.
I would recommend Mr. Mcnanmara to anyone at any time. He was the best attorney that my family and I came in contact with. About three years ago we had a very tragic, accidental death in our family and the company knew that it was their fault but of course tried passing the buck. Mr.
Price and Sara are great. They helped us in a time of need. Their communication was always spot on and I never felt out of the loop with what was going on with our case.
Price is very professional, honest, and reliable. Whatever he says, he will follow through with the utmost integrity. He will turn over every stone and pays close attention to even the smallest detail. I’m glad I secured his services.
Without going into the painful details regarding the reason for having to hire Price, his compassion and communication helped my family during an extremely difficult time. If you need legal help because you or a family member was injured by something or someone else, don’t hesitate to call him.
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