At first glance, it may seem like the Employee Retirement Income Security Act of 1974 (ERISA) has nothing to do with your long-term disability insurance claim. Right now, you are not concerned about your retirement benefits. You are disabled and unable to work. Therefore, you are rightly concerned about the long-term disability insurance benefits that are provided by your employer.
ERISA Applies to Most Employer-Sponsored Long-Term Disability Benefits
ERISA does not apply to benefits provided by a government (or public) employer or a religious employer. For example, ERISA typically does not apply to long-term disability benefits provided to public school teachers or church employees. However, ERISA does apply to most other workers in the private sector who have long-term disability insurance provided through their employer.
ERISA May Protect Your Right to File a Long-Term Disability Claim
If ERISA applies to your long-term disability coverage then:
You should be notified of your coverage and benefits.
You should be informed about how to file a claim.
The insurance company has a limited amount of time to decide whether to allow or to deny your claim.
Your employer may not fire you or discriminate against you for filing a claim.
Of course, this does not mean that the insurance company must approve your claim.
ERISA Affects Your Rights If Long-Term Disability Benefits Are Denied
ERISA has many specific provisions that may impact you if your claim for long-term disability benefits is denied. This includes the following:
You must be provided a written reason for the denial of your claim.
At your request, you must be provided with copies of your record including any documents relevant to your claim. This must be provided to you free of charge.
You must be provided with the right to appeal. Typically, you must be provided at least 180 days to file your appeal. If you miss this deadline then your right to file an appeal or a lawsuit may be terminated and the initial decision to deny your long-term disability benefit coverage may end.
A decision on your appeal should happen relatively quickly. Typically, the insurance company has 45 days to make a decision once your written appeal is received. However, the insurance company may request a 45-day extension. If an extension is requested, then you will be notified in writing.
If your claim is denied on appeal, then what happens next depends on the specific provisions of your plan. You may need to go through a second round of appeal. Alternatively, you may be able to file a lawsuit.
If your claim is denied after one or two appeals (depending on the specifics of your plan) then you have the right to file a lawsuit. You must file your case in federal court within the timelines specified in your long-term disability benefits plan.
Only limited evidence can be submitted in an ERISA lawsuit. For the most part, the evidence that will be considered by the court will be the evidence that was available to the insurance company at the last stage of appeal. However, limited discovery may be allowed on certain issues in some cases.
This is meant to be an overview of some of the important rights established by ERISA. Other ERISA provisions are also likely to apply to your claim.
ERISA is a Complex Law – Get the Help You Deserve Enforcing Your Right to Long Term Disability Benefits
You have a lot at stake. You are disabled and unable to work. All you are asking for is the long-term disability benefits that you earned while working for your employer. Unfortunately, the insurance company that is responsible for paying those benefits may unfairly fight your claim.
The insurance company has skilled professionals working to protect its interests, and you deserve the same advantage. Please contact the experienced disability lawyers at Keefe Disability Law to learn more about how you can protect your rights and about how we can help you. We would be pleased to schedule a free, no-obligation consultation with you at your convenience. Call us or reach out to us via this website today if you are filing an initial long-term disability claim or if you are pursuing an appeal.