Workers with comprehensive employment benefits packages may have several types of insurance provided by their employers. In addition to basic health insurance, they may also have long-term and short-term disability insurance provided by their employers.
Such policies are subject to the rules established by the Employee Retirement Income Security Act of 1974 (ERISA). ERISA protects people from unfair disability benefit denials that could have profound financial implications.
Typically, insurance companies reviewing ERISA-governed long-term or short-term disability claims have to make determinations based on the best interests of policyholders. They also have to allow policyholders to pursue an internal appeal. In scenarios where the appeal process is not successful, professionals in need of disability benefits can potentially file lawsuits.
Wrongful claim denials are actionable
ERISA does not allow for multiple internal appeals. Insurance companies only have to allow a single appeal to remain compliant with the law. However, they need to consider the documentation provided by a policyholder carefully during the initial claim and the appeal. When workers have medical challenges that prevent them from working, their long-term or short-term disability benefits may be the only source of financial support available to them.
If a company unjustly denies a policyholder benefits, the affected individual can file a lawsuit. During litigation, the evidence previously provided to the insurance company becomes the primary supporting evidence for the plaintiff. An administrative law judge reviews the matter to determine if the insurance provider may have wrongfully denied the applicant benefits.
If the judge rules in favor of the applicant, they can receive the benefits that they need. The insurance provider could also be at risk of penalties due to non-compliance with ERISA regulations. Preparing for wrongful benefit denial lawsuits technically begins during the appeals process. After all, the evidence submitted during the appeal becomes the evidence that supports the allegations of a wrongful claim denial.
The complexities of ERISA policies and the appeals process can make it important for those pursuing disability benefits to secure support. Partnering with a professional familiar with ERISA disability claims may help individuals secure the benefits they need while dealing with a debilitating medical condition. Those dealing with a wrongful denial of benefits may eventually prevail if they act quickly and secure appropriate help.