Certain worker benefits provided by employers are subject to federal regulation. For example, those who have short-term or long-term disability insurance coverage provided by their employers typically have certain protections thanks to the Employee Retirement Income Security Act of 1974 (ERISA).
Despite what the name implies, ERISA applies not just to retirement benefits but also other financial benefits and insurance provided through employers. ERISA creates certain rules for companies and certain rights for the workers who receive such benefits.
Someone filing a claim for short-term or long-term disability benefits via a policy governed by ERISA has the right to initiate an appeal after a claim denial. How many appeals are available?
Each claim only gets one appeal
Certain programs, like federal disability benefits, have multiple stages of appeal. After an unsuccessful initial appeal, applicants can take the matter to a higher authority to continue seeking the benefits they believe they deserve.
That typically is not an option for those appealing an unfavorable decision related to ERISA-governed disability benefits. Currently, the law only ensures the right to a single appeal. However, it is possible to initiate litigation after an unsuccessful appeal.
Applicants typically want to ensure that they submit appropriate documentation during the appeals process, as the evidence provided during the appeal will largely determine what they can submit as evidence to the court during litigation later.
Even if the appeal is not successful, applicants denied benefits that they likely deserve still have other options. Learning about the rights extended to individuals under ERISA may help those who need coverage provided as an employment benefit.