What is the ERISA claim process?

On Behalf of | Jul 7, 2022 | ERISA Disability Benefits

The Employment Retirement Income Security Act, or ERISA, is a law that dictates the way that claims for retirement, disability, dental and health benefits have to be handled. If you’re hurt at work, ERISA may dictate the way that your insurance claim should be handled as you seek disability benefits.

The ERISA claims process is relatively straightforward. To start with:

  • You will file an initial disability insurance claim.
  • Then, the insurance company will start an investigation. If you don’t get your claim approved, you’ll need to go through the appeals process.
  • If you can’t successfully appeal the claim, you’ll need to file a lawsuit in court.

Many people are able to get approved upon their initial claim, but that’s not always the case. That’s why it’s important for you to provide significant information to the insurance company when you do file your claim. Include information like your financial records, statements from your attending physicians and your medical records.

When the insurance company does a review of your case, it’s possible that it could deny your claim based on the information it has in hand. Since the entire process can take up to 105 days, then that means that you could be waiting several months to find out if the insurance company will approve your claim. In some cases, the insurer can even ask for an extension.

Keep in mind that you can file a lawsuit if the insurance company doesn’t ask for an extension and takes longer than 105 days to make a decision on the initial claim.

What do you do if you have a claim denied?

You have a right to appeal any ERISA claims denial, which could help you get the benefits you need. At that point, it’s usually valuable to have legal support, as an attorney will have a good understanding of ERISA and what it would take to make a successful appeal. Additionally, if your appeal is denied, your attorney will be able to help you take your claim to court through a lawsuit. In court, you may be able to successfully argue for the benefits you deserve and hold the insurance company or your employer liable for any wrongdoing.