Certain employee benefits are subject to federal regulations. Obviously, pensions and retirement benefits are subject to the provisions of the Employee Retirement Income Security Act of 1974 (ERISA). Other benefits are also subject to the provisions of ERISA.
If employers provide short-term or long-term disability insurance coverage to workers, ERISA typically applies to those benefits as well. Under ERISA, insurance professionals responding to claims from those who need disability coverage have a fiduciary duty to the policyholder rather than an obligation to their employers. Additionally, the law protects the right of the policyholder to appeal an unfavorable decision. How can workers in need of long-term disability benefits prepare for an appeal?
Secure legal support
Anyone trying to navigate a complex insurance matter may require legal guidance. When confusing federal statutes, such as ERISA, apply, legal insight is all the more important.
Workers can improve their chances of immediate approval by having legal assistance as they initially apply for benefits. Those who need to appeal can take policy paperwork and the rejection notice to a lawyer familiar with ERISA to begin strategizing for an appeal.
Gather medical documentation
Some long-term disability rejections occur due to technical errors. Other times, the justification for the decision relates to insufficient medical evidence. A single piece of paper affirming a diagnosis is not enough to ensure that a professional qualifies for long-term disability benefits.
They may need to undergo a functional capacity evaluation or other in-depth testing to establish the severity of their symptoms. They may also need to gather information about their treatment to affirm that the condition is severe enough to prevent them from working.
Adequate evidence during the appeal stage is critical, as ERISA only guarantees the right to a single internal appeal. If the policyholder needs to litigate to get benefits, they must rely on the evidence submitted to the insurance company previously in court.
The more they provide, the better their chances of a successful appeal. Even if the appeal is unsuccessful, the right details in their documentation can set them up for effective litigation.
Act quickly
There is a limited window of opportunity in which to appeal and to file a civil lawsuit over ERISA-governed disability benefits. Responding promptly can make all the difference.
Those concerned about a rejected long-term disability benefits application can appeal the decision in pursuit of the benefits they need. Following the right steps can help increase the likelihood of an ERISA disability appeal being successful.