What Is ERISA?
The Employee Retirement Income Security Act (ERISA) is a federal law that sets minimum standards for most private employee benefit plans, including long-term disability (LTD) insurance. ERISA was enacted in 1974 to protect employees’ benefits by setting minimum standards for these plans.
ERISA requires employers and insurance companies to provide clear information about benefits and ensure that plan administrators act in the participants’ best interests. ERISA also establishes a process for participants to file claims and appeals if they are denied benefits.
If you have an LTD plan through your employer, it is likely governed by ERISA. ERISA’s rules and regulations can have a significant impact on your LTD claim, so it’s important to understand your rights.
What is Long-Term Disability Insurance?
Long term disability insurance replaces a percentage of your income if you are unable to work for an extended period of time as a result of your disability. LTD plans can be offered as a part of an employer’s benefits package, or they can be purchased individually.
LTD policies typically have a waiting period of a few months before benefits begin and pay out a percentage of your income. Depending on the policy, benefits may last for a few years or until you reach retirement age.
If you are unable to work, you will need to file a claim with your LTD insurance provider to receive benefits. The insurance company will review your claim to determine if you meet the policy’s definition of disability and are eligible for benefits.
How ERISA Affects Your Long-Term Disability Claim
If you have an ERISA LTD plan, you must follow specific rules and regulations when filing or appealing your claim. Here are a few key things to keep in mind:
- ERISA requires plan administrators to provide you with clear and complete information about your benefits. This includes the plan’s terms, your eligibility for benefits, and the procedures for filing and appealing claims.
- ERISA provides you with the right to file a claim for benefits and to appeal a denial of benefits. You must follow the plan’s internal appeals process before you can file a lawsuit in court.
- ERISA sets forth strict deadlines for filing claims and appeals. You typically 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 the plan’s participants rather than their own best interests. This means that they have to make decisions about your claim based on the evidence and the plan’s terms.
- ERISA limits the damages you can recover if you win a lawsuit against your insurance company. You may only recover the benefits you were wrongfully denied, interest on those benefits, and attorneys’ fees.
Navigating the ERISA Claims Process
Filing an LTD claim under ERISA can be a complex and confusing process. Here are a few tips to help you navigate the claims process:
- Read and understand your plan’s terms. 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 necessary 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 you can file a lawsuit in court. This typically involves submitting additional documentation and presenting your case to an independent reviewer.
- Seek legal advice if necessary. If you are having difficulty with the claims process or believe that your insurance company is acting in bad faith, consult with an ERISA attorney.
- Keep track of and adhere to all deadlines. ERISA has strict deadlines for claims and appeals, so keep track of these deadlines and submit your paperwork on time.
What to Do if Your Claim is Denied
If your LTD claim is denied, you have the right to appeal the decision through the plan’s internal appeals process. This typically involves submitting additional documentation and presenting your case to an independent reviewer.
If your claim is still denied after exhausting all of your 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’s rules and regulations can vary depending on the specific plan and insurance company. You should carefully review your plan’s terms and consult with an attorney who specializes in ERISA claims to ensure that you understand your rights and options.
In conclusion, ERISA is a federal law that governs most private employee benefit plans, including long-term disability insurance. ERISA’s 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 you have an LTD plan through your employer, be sure to read and understand your plan’s terms, gather and submit all necessary documentation, and follow the plan’s appeals process if your claim is denied.
If you’re having difficulty with the claims process or believe that your insurance company is acting in bad faith, seek legal advice from an attorney who specializes in ERISA claims. Understanding your rights and how to navigate the claims process effectively will increase your chances of receiving the benefits you’re entitled to under your LTD plan.
Request a Free Consultation
If your ERISA disability claim has been denied or terminated, we can help. Call Ortiz Law Firm at (888) 321-8131 to schedule a free consultation with an experienced ERISA disability attorney.