Common Reasons for ERISA Long-Term Disability Insurance Denial in Texas

No matter your reason for applying for long-term disability insurance benefits, you should be able to receive these valuable benefits if you paid the premiums for this insurance. However, finding out that your long-term disability insurance benefits were denied can be shocking, devastating, and worst of all, more likely than you may think.

If you are in this situation and wondering how to continue paying your bills while you are unable to earn a paycheck, you are unfortunately not alone. According to the Bureau of Labor Statistics, as many as 70 percent of ERISA long-term disability claims are denied.

Fortunately, you may be able to appeal your claim denial with the help of an experienced ERISA attorney. In the meantime, reviewing the common reasons for ERISA long-term disability insurance denial in Texas can be beneficial before filing your appeal.

The Employee Retirement Income Security Act

The Employee Retirement Income Security Act (ERISA) become federal law in 1974. Enacted to protect the rights and interests of participants in and beneficiaries to health and welfare plans, this law applies to most private sector insurance benefits. It does not apply to employees working for churches, the government, or in Indian tribunes. Under ERISA, if a participant is denied benefits they have certain rights such as appealing the denial and even suing to receive their benefits.

Why Are Long Term Disability Claims Denied?

Denials of ERISA long-term disability insurance claims occur in Texas for a variety of reasons. Knowing the two most common reasons for such a denial can be helpful in preparing a strong appeal or fighting the denial in court.

Lack of Medical Evidence

Long-term disability insurance claims are most likely to be denied due to lack of medical evidence. In an active claims process, the claimant must provide medical records that prove they have an inability to work.

However, most insurance companies have their own medical professionals—who usually have a vested financial interest in claim denials—to review the medical records of claimants. Additionally, many insurance companies may deny a claim with accurate and complete medical evidence in the hopes that the claimant will not pursue any further action.

Claimants planning to appeal their denied claim should be sure that all relevant medical evidence and documentation is included in their file and is completely accurate. Once an appeal is denied, no further information can be added to the file before taking the case to court.

Improper Filing

The ERISA claims process—not to mention individual insurance company requirements—can make the claims process complex and difficult to understand. Sometimes insurance companies take advantage of this fact to deny more claims. Even a small mistake can disqualify a claimant from receiving the ERISA long-term disability benefits they are entitled to, making assistance from an attorney specializing in ERISA cases all the more important.

Talking to a Texas ERISA Attorney

If your ERISA long-term disability insurance claim was denied, you have the right under the Act’s regulations to appeal your claim and, if the appeal is denied, to file a lawsuit. A skilled ERISA lawyer can review the common reasons for ERISA long-term disability insurance denial in Texas with you to help your case going forward.

Despite the high number of denials, it is possible to fight for and win the right to access the benefits you paid for. Contact a knowledgeable attorney today to learn more about your options after an ERISA claim denial.

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