Employees are covered by short and long-term disability benefits programs. And most employers use the Employee Retirement Income Security Act of 1974 (ERISA). This law includes plans that cover temporary or permanent disabilities caused by cancer, an injury or a chronic condition, such as fibromyalgia, mental illness and lung ailments.
If you suffer from any condition that makes it hard for you to work, you should consider filing an ERISA claim. But before doing so, here is what you need to know.
Exhaust administrative remedies
You may be required to exhaust administrative remedies before filing an ERISA claim. This means following internal processes and filing a claim with the insurance company. They will review your case and ask you to submit evidence before providing a final decision. When they deny your claim and appeal, you can consider ERISA.
Time is crucial
If the insurance company denies your claims, you should act accordingly sooner. Get more information about your employer’s ERISA benefit plan and learn if you are eligible for its benefits. Further, understand how the claim process works and how to appeal should you get an unsatisfactory outcome.
Your application can be denied
ERISA does not provide certain benefits to employees. For instance, this act may not cover you for a benefit that can be solved by workers’ compensation. It also does not cover plans for government entities and churches. Thus, an application that falls under these categories may be denied.
Nonetheless, you may be eligible for ERISA benefits, but your claim can be wrongfully denied. In this case, you can appeal to receive the benefits you deserve.
The ERISA claim process can be complex. It may be best to get legal guidance to avoid costly mistakes.