Understanding an ERISA appeal process

On Behalf of | May 10, 2022 | ERISA Process And Procedures

Employee Retirement Income Security Act (ERISA) is a set of federal laws that are designed to protect employee benefits such as healthcare, retirement, stock and disability benefits. Basically, ERISA was founded to protect employees’ retirement plans and welfare benefits from abuse and mismanagement by insurance companies. 

ERISA laws are quite complex and can be course-specific. It is not uncommon for insurance companies to deny long-term disability claims that fall under ERISA. Fortunately, a claims denial is not the end of the road.

Common reasons for ERISA claims denial

Your disability claim may be denied for a number of reasons. For instance, paperwork mistakes or missing something in your policy’s fine print could result in a denial. Here are common reasons why your long-term disability claim could be denied:

  • If you fail to provide adequate medical documentation on your disability
  • If you have a pre-existing condition
  • If the claim is not covered by your policy
  • If the evidence compiled by the insurance company’s investigators contradicts your claims
  • Undocumented symptoms or inappropriate treatment

Filing an ERISA appeal

If your ERISA claim is denied, you will have up to 180 days to file your appeal. You will typically be notified of the reasons for your claim’s denial by the insurance company. It is important that you be on the lookout for any notice or information from the insurance company during the claim period. If you are corresponding via mail, be sure that important information does not end up in the spam folder. 

Here is important information that you should consider submitting during your ERISA appeal:

  • Any new evidence you might have gathered such as medical reports, court rulings and expert reports
  • Signed affidavits from friends and family who were familiar with your health condition and/or circumstances.

The news of a long-term disability claims denial can be devastating if you have diligently paid your premiums for years. Find out the legal steps you can take to overturn a denied ERISA claim.