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What Is ERISA And How Does It Affect My Long-Term Disability Claim?

What Is ERISA?

The Employee Retirement Income Security Act (ERISA) is a federal law originally enacted in 1974 to protect employees’ rights to collect employee retirement benefits, particularly pension benefits. Over time, the courts expanded the reach of ERISA to cover other “fringe” employee benefits such as long-term disability, health insurance, life insurance, and other benefits provided by employers.

If you have a group plan through your employer, it is likely governed by ERISA. Individual disability insurance plans usually are not subject to ERISA. ERISA’s rules and regulations can significantly impact your LTD claim, so it’s important to understand your rights. 

How Does ERISA Affect My Long-Term Disability Claim?

ERISA requires employers and insurance companies to provide clear information about benefits and ensure that plan administrators act in the participant’s best interests. ERISA also establishes a process for participants to file appeals if their benefits are denied. If you have an ERISA LTD plan, you and the plan administrator must follow specific rules and regulations. Here are a few key things to keep in mind: 

  1. ERISA requires plan administrators to provide clear and complete information about your benefits. This includes the plan’s terms, your eligibility for benefits, and the procedures for filing and appealing claims.
  2. ERISA allows you to file a claim for benefits and appeal a denial of benefits. You must follow the plan’s internal appeals process before filing a lawsuit in court.
  3. ERISA sets forth strict deadlines for filing claims and appeals. You typically have a limited number of days to file an initial claim and 60, 90, or 180 days to appeal a denial of benefits (depending on what your policy says).
  4. ERISA requires plan administrators to act in the best interests of the plan’s participants rather than their own best interests. They must decide your claim based on the evidence and the plan’s terms.
  5. ERISA limits the damages you can recover if you win a lawsuit against your insurance company. You may only recover the benefits you were wrongfully denied, interest on those benefits, and attorneys’ fees. In most circumstances, punitive damages are not available in ERISA group plan benefit claims.

RELATED POST: Is Your Long-Term Disability Claim Governed By ERISA? Key Signs To Look For

Filing an LTD claim under ERISA can be a complex and confusing process. Here are a few tips to help you navigate the claims process: 

  1. Read and understand your plan’s terms. Your plan document will outline the eligibility requirements for benefits, the definition of disability, and the procedures for filing and appealing claims.
  2. Gather and submit all necessary documentation. Your claim will be reviewed based on the evidence you provide, so it’s important to submit all relevant medical records, employment records, and other supporting documentation.
  3. Follow the plan’s appeals process. If your claim is denied, you must follow the plan’s internal appeals process before filing a lawsuit in court. This typically involves submitting additional documentation and presenting your case to an independent reviewer.
  4. Seek legal advice if necessary. If you are struggling with the claims process or believe your insurance company is acting in bad faith, consult an ERISA attorney.
  5. Keep track of and adhere to all deadlines. ERISA has strict deadlines for claims and appeals, so keep track of these deadlines and submit your paperwork on time.

What To Do If Your ERISA Disability Claim Is Denied 

If your LTD claim is denied, you can appeal the decision through the plan’s internal appeals process. This typically involves submitting additional documentation and presenting your case to an independent reviewer. 

If your claim is still denied after exhausting all of your administrative remedies, you may be able to file a lawsuit in court. However, ERISA limits the damages you can recover in a lawsuit, so it’s important to understand the potential risks and benefits of pursuing legal action. 

It’s also important to note that ERISA’s rules and regulations can vary depending on the specific plan and insurance company. You should carefully review your plan’s terms and consult with an attorney who specializes in ERISA claims to ensure you understand your rights and options.

RELATED POST: Adverse Benefit Determinations In ERISA Long-Term Disability Claims

Request a Free Case Review by an ERISA Disability Attorney

ERISA is a federal law that governs most private employee benefit plans, including long-term disability insurance. ERISA’s rules and regulations can significantly impact your LTD claim. Understanding your rights and the claims process will increase your chances of receiving the benefits you’re entitled to under your LTD plan. 

If you’re having difficulty with the claims process or believe your insurance company is acting in bad faith, seek legal advice from an attorney specializing in ERISA claims. If your disability claim has been denied or terminated, we can help. Call the Ortiz Law Firm at (888) 321-8131 to schedule a free disability case review with an experienced ERISA disability attorney. 

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