Navigating the world of long-term disability claims can be daunting, especially when you throw ERISA into the mix. The Employee Retirement Income Security Act (ERISA) isn’t just another piece of legislation; it’s a pivotal law that can profoundly affect your ability to secure disability benefits through your employer.
Whether you’re just starting the claims process or dealing with a denial, understanding ERISA is critical to protecting your rights and ensuring you get the benefits you deserve. In this article, we’ll break down what ERISA is, how it affects your long-term disability claim, and provide you with actionable steps for navigating the complex claims process.
What is ERISA?
The Employee Retirement Income Security Act is a federal law originally enacted in 1974 to protect the rights of employees to receive retirement benefits, particularly pension benefits. Over time, the courts have expanded the reach of ERISA to cover other “fringe” employee benefits, such as long-term disability, health and life insurance, and other employer-provided benefits.
What is an ERISA Long-Term Disability Claim?
If you have a group disability plan through your employer, it is likely governed by ERISA. Individual disability insurance plans are generally not subject to ERISA. ERISA rules and regulations can significantly affect your LTD claim, so it’s important to understand your rights.
How Does ERISA Affect My LTD Claim?
ERISA requires employers and insurance companies to provide clear information about benefits and to ensure that plan administrators act in the participants’ best interests. ERISA also establishes a process for participants to appeal denials of benefits.
If you have an ERISA LTD plan, you and the plan administrator must follow certain rules and regulations. Here are some important things to keep in mind:
- ERISA requires plan administrators to give you clear and complete information about your benefits. This includes the terms of the plan, your eligibility for benefits, and the procedures for filing and appealing claims.
- ERISA allows you to file a claim for benefits and to appeal a denial of benefits. You must follow the plan’s internal appeals process before filing a lawsuit in court.
- ERISA has strict time limits for filing claims and appeals. You usually have a limited number of days to file an initial claim and 60, 90, or 180 days to appeal a denial of benefits (depending on what your policy says).
- ERISA requires plan administrators to act in the best interests of plan participants, not their own. They must decide your claim based on the evidence and the terms of the plan.
- ERISA limits the damages you can recover if you win a lawsuit against your insurance company. You can only recover the benefits you were wrongly denied, interest on those benefits, and attorneys’ fees. In most cases, punitive damages are not available in ERISA group plan benefit claims.
Navigating the ERISA Claims Process
Filing an LTD claim under ERISA can be a complex and confusing process. Here are some tips to help you navigate the claims process:
- Read and understand the terms of your plan. Your plan document will outline the eligibility requirements for benefits, the definition of disability, and the procedures for filing and appealing claims.
- Gather and submit all required documentation. Your claim will be reviewed based on the evidence you provide, so it’s important to submit all relevant medical records, employment records, and other supporting documentation.
- Follow the plan’s appeals process. If your claim is denied, you must follow the plan’s internal appeals process before filing a lawsuit in court. This usually involves submitting additional documentation and presenting your case to an independent reviewer.
- Seek legal advice if necessary. If you are struggling with the claims process or believe your insurance company is acting in bad faith, consult an ERISA attorney.
- Keep track of and meet all deadlines. ERISA has strict deadlines for claims and appeals, so keep track of them and submit your paperwork on time.
What to Do If Your ERISA Disability Claim Is Denied
If your LTD claim is denied, you can appeal the decision through the plan’s internal appeals process. This usually involves submitting additional documentation and presenting your case to an independent reviewer.
If your claim is still denied after you have exhausted all administrative remedies, you may be able to file a lawsuit in court. However, ERISA limits the damages you can recover in a lawsuit, so it’s important to understand the potential risks and benefits of pursuing legal action.
It’s also important to note that ERISA rules and regulations may vary by plan and insurance company. You should carefully review your plan’s terms and consult with an attorney who specializes in ERISA claims to ensure you understand your rights and options.
Request a Free Case Review from an ERISA Disability Lawyer
ERISA is a federal law that governs most long-term disability insurance plans. ERISA rules and regulations can have a significant impact on your LTD claim, so it’s important to understand how the law affects your rights. If your claim has been denied or you believe your insurance company is acting in bad faith, seek legal advice from an attorney who specializes in ERISA claims. Call us at (888) 321-8131 to schedule a free case review with experienced ERISA disability attorney Nick Ortiz.
