Most people (understandably) aren’t familiar with the terms of their long-term or short-term disability coverage in detail. Employers that offer disability benefits as part of a compensation package typically provide policy documents to employees. However, the typical professional struggles to make sense of the dense language included in those papers.
People often don’t invest much at energy into learning about disability benefits because they assume that they, like most other people, may never require those benefits. Only a small portion of those with disability benefits ever need their coverage, but those who do depend on it because they cannot work.
As such, when someone applies for benefits, they expect to receive the financial support they require. Yet, some people receive a rejection notice instead. Those who have policies provided by their employers have the right to appeal an unfavorable decision.
Why appeals are important
Especially in scenarios where an individual begins the claims process on their own, they can easily make mistakes. Perhaps they don’t submit adequate medical records with their claim paperwork, or they make technical mistakes on the document. Without the right to appeal, those errors could block someone out of the coverage that they require and deserve.
The Employee Retirement Income Security Act of 1974 established numerous guidelines for benefits provided to workers by employers. The law governs not just retirement benefits and pensions but also disability benefits.
The right to an internal appeal at the insurance company is a key protection enshrined in ERISA. Policyholders can ask the insurance company to reconsider their claims. They also have the opportunity to work with an attorney to correct any errors in their paperwork and gather the necessary evidence to make their claim more convincing.
The appeals process needs to happen relatively quickly, so people must prepare as rapidly as possible when they set out to appeal an unfavorable decision. Given that ERISA also requires that insurance companies prioritize the best interests of policyholders, some ERISA appeals can potentially lead to workers getting benefits. Other times, individuals adjusting to life with a disabling medical condition may need to initiate legal action against the insurance company.
Having assistance when preparing for and navigating an ERISA appeal could increase someone’s chances of success. Policyholders who understand their rights are in the best position to get the coverage they deserve from a policy governed by ERISA.