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Willeford & Toledano - ERISA
Call an experienced disability benefits lawyer at 877-281-4789 to schedule your consultation.

Why was my ERISA claims denied?

On Behalf of | May 23, 2022 | ERISA Disability

The Employee Retirement Income Security Act (ERISA) was designed to provide relief for American workers by protecting them from mischievous employers who promise handsome pensions only to disappear when retirement comes around. Besides protecting employee pensions, ERISA is also meant to regulate the conduct of insurance companies that manage employee benefits.

If you become disabled to the point that you can no longer work, you may be eligible for cover under your employer’s long-term disability plan. ERISA provides disabled workers monetary benefits until they can resume work. However, it is not uncommon for the insurance company to come up with reasons to deny you cover and/or claim.

Understanding reasons for ERISA denial

An ERISA claim denial can be troubling. If your ERISA claim is denied, it is important that you understand the reasons for the denial so you can figure out how to file an appeal.

Sometimes, a denial can be made in error, and understanding the circumstances that can lead to denial can help you file a successful appeal. Here are common reasons why your ERISA claim may be denied:

  • You did not provide adequate documentation regarding your disability
  • You had a preexisting condition
  • You overlooked important deadlines or made mistakes while filing the paperwork
  • Evidence gathered by the private investigation or on social media contradicts your claim
  • You received unauthorized treatment or had undocumented symptoms
  • You self-reported your symptoms without medical backup

So what are your options following a claims denial?

If your claim is denied, you will have up to 180 days to appeal the denial. During the appeal, it is important that you provide additional evidence to support your claim. This can be in the form of the doctor’s report and testimony from family or co-workers who are aware of your condition and circumstances.

It is not unusual for a legitimate disability claim to be denied by the insurance company. Find out how you can protect your rights and interests when filing or appealing an ERISA claim