Many workers in well-compensated positions have complex benefits packages. Employers might offer disability benefits in addition to health insurance and paid leave. Workers often do not evaluate those benefits very closely until they suddenly need them.
A surprise medical event like a stroke or an incident like a car crash can leave a previously independent professional unable to continue working. In such situations, they may suddenly become dependent on the disability benefits provided by their employers.
Unfortunately, not all workers receive prompt approval when they make claims for benefits. Some end up rejected and have to appeal. The Employee Retirement Income Security Act of 1974 (ERISA) includes the right to appeal an unfavorable decision. The law only guarantees the right to a single internal appeal with the insurance provider. How do workers prepare for that appeal?
By getting proper assistance
ERISA claims tend to be a bit more complicated than smaller insurance claims. They can represent tens or hundreds of thousands of dollars in obligations for insurance companies. The professionals working at those companies are likely to negotiate quite aggressively to limit company liability.
There are also very strict deadlines that apply to appealing unfavorable determinations. People already dealing with debilitating medical conditions likely need help navigating a disability appeal.
By undergoing a medical review
One of the most common reasons for an ERISA disability claim denial is a lack of compelling medical evidence. Basic records of an injury or a diagnosis may not be enough to convince the company that disability benefits are truly necessary.
Workers may need to submit to a multiple-hour test to establish the legitimacy of their condition and the extent to which it impacts their day-to-day lives. A functional capacity evaluation is a common test performed in scenarios involving significant or long-term disability claims.
The more medical evidence the applicant has, the better their chances of prevailing when they appeal. The evidence submitted during the appeals process has a direct influence on the policyholder’s rights in the future.
The evidence submitted during the appeal typically becomes the only evidence that they can present if they pursue litigation after an unsuccessful appeal. It is therefore crucial to have robust medical evidence during the appeals process.
Injured workers worried about covering their costs when they cannot work may need help appealing a rejected ERISA disability claim or filing a lawsuit. Getting assistance can allow the injured party to focus on their comfort and recovery rather than on the minutiae of a complex insurance claim.