Understanding ERISA disability claims

When you’re a worker for a company who has offered you disability insurance, you may not be aware of ERISA, or the Employee Retirement Income Security Act. Why would a retirement act impact your disability claim? And how could it possibly cause a denial of that claim? You need to know how the insurance system works so that you can recover from an ERISA disability claim denial.

What is an ERISA disability claim?

First, let’s start with the basics. There are actually two different types of disability insurance plans: ERISA or individual Long-Term Disability (LTD) plans. Most employer-provided LTD plans are governed by ERISA, while individual plans are not. Individual plans are more expensive because they are not subsidized by your employer, but ERISA plans may have a higher chance of denying coverage. This is because ERISA has a host of regulations about how to file a claim, which can easily be missed, and ERISA rules usually favor insurance companies.

What does this denial mean for workers?

When your ERISA disability claim is denied, you might experience many negative effects. For one, you can’t sue the insurance company for not following through. Two, your disability may have left you without the ability to work again, and ERISA has blocked future income. ERISA also gives insurance the leeway to conceal the correctness of their denial; companies only have to show that they weren’t arbitrary or capricious when they denied the claim. As you can see, that doesn’t leave you with much to go on.

What happens when your ERISA disability claim is denied?

If your ERISA disability claim is denied, you experience enough negativity to compel you to take action. But what should you do? You can’t take on the insurance company on your own, and you can’t sue for wrongful treatment. However, you can hire a lawyer to look closely at your case. You need an attorney to determine if your case could possibly be outside of ERISA jurisdiction, for one. For another, an attorney can discover if someone other than you or your insurance company can be considered at fault for the denial.

As you can see, while an ERISA disability claim denial is painful, it doesn’t have to stay that way. You can stand up for justice with an attorney at your side to help you find the loopholes that will get you the disability coverage you have contracted for. Don’t let ERISA stand in your way.

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