Were you shocked to receive notice that your disability claim under the Employee Retirement Income Security Act (ERISA) was denied? Unfortunately, a great many others share your fate and have had their claims initially rejected by insurance providers.
You can still pursue your ERISA disability claim, but a denial usually means waiting even longer to access your benefits. Knowing why insurers often reject ERISA claims may help you succeed the first time you try to have your claim approved.
Lack of medical evidence
ERISA agents or administrators cannot approve disability claims without medical evidence that supports the need for benefits. Copies of records from your official medical file can serve as evidence. A statement from your treating doctor with comprehensive details about your abilities and restrictions is another form of medical evidence.
Other documentation mistakes like missing a deadline or omitting required paperwork can also result in a rejection.
Surveillance refutes your claim
Insurers dislike parting with money and will leave no stone unturned when investigating claims. They may delve into your social media accounts to look for evidence refuting your claim (skiing images, etc.). Some ERISA insurers may go as far as engaging a private investigator to record your daily activities for a time.
If the investigator obtains video surveillance suggesting you are not as disabled as you claimed, the insurer will probably deny your claim.
Reviewing your documentation carefully before you submit your claim can help prevent a denial. If you receive a denial anyway, it is not the end of the road. Legal guidance could help to ensure your appeal is correct, timely and ready for approval.