Many workers who have complex compensation packages expect that they will likely never need those benefits. Employers may provide long-term and short-term disability insurance coverage as part of a robust compensation package. Employee benefits that include supplemental insurance help protect workers against the possibility that future medical issues could prevent them from earning what they need to support their families.
Most people spend very little time reviewing such benefits and may be entirely unfamiliar with what rules protect them until they find themselves in need of disability coverage. After a sudden injury or a major medical event puts someone in the hospital or leaves them unable to work, they may turn to their employer-sponsored benefits.
However, the insurance company may respond by denying their claim. What should workers do if their long-term disability benefits claim is denied?
Workers may need to learn about the law
The average employee is likely unfamiliar with the Employee Retirement Income Security Act of 1974 (ERISA). This law is the most important federal statute for those seeking to make use of employer-sponsored benefits, like long-term disability coverage.
The law imposes several requirements on companies offering benefits and insurance providers underwriting these policies. The insurance company generally has a fiduciary duty to act in the best interests of the party making the claim. The company also has an obligation to offer appeals for those who get rejected when they apply.
The ERISA appeals process needs to begin relatively soon after a denied claim. Federal rules typically protect someone’s right to take action within 180 days of an insurance provider denying their claim. Therefore, timely action is of the utmost importance.
The average person needs support when navigating an ERISA-related insurance matter. Not only are they likely unfamiliar with the law, but they already have medical issues to deal with while appealing. Adding the stress of a complex insurance claim on top of that could endanger their health. They might also make mistakes or oversights that leave them at increased risk of failing when they appeal.
A lawyer understands how important the appeals process is. Even if the appeal is unsuccessful, the evidence used in the appeal is what provides the basis for any legal action taken after the appeal. Ideally, an insurance provider realizes its mistake when an applicant appeals an unfavorable determination about long-term disability benefits.
Not all appeals are successful, and so applicants need to prepare for the possibility that they may need to take legal action to get the benefits that they deserve. Making sense of the rules that apply during ERISA benefits claims, and seeking legal guidance accordingly, can make a major difference for those in need of benefits because they cannot work.
