What Are Your Options When Your ERISA Claim Has Been Denied?

When you’re unable to work due to a mental or physical condition, you should be able to rely on the long-term disability benefits provided by your employer’s insurance policy. However, the denial of valid claims is common. The good news is that an initial denial does not mark the end of the road. You have the option to appeal the denial of a claim.

What Does the Appeals Process Look Like?

The Employee Retirement Income Security Act (ERISA) has a requirement that long-term disability insurance providers must include an appeals process as part of their coverage. This gives you the right to request a review of your claim by someone who did not take part in the initial denial of your claim. The person who considers your appeal may not look to the initial decision or the reasons for the denial when reviewing your claim.

It’s important to remember that there are filing deadlines. You have 180 days to provide the insurer with your appeal. You are allowed to include any new information regarding your condition as part of the appeal. For example, if you’ve received a new medical diagnosis, have gathered additional medical support evidence, or your condition has worsened, you should be sure to include this information.

Voluntary and Second Appeals

Some insurance companies include an additional level of appeals. These are known as voluntary or second appeals. Once again, you shouldn’t delay filing this type of appeal, although the insurance provider must allow you a reasonable amount of time to get your voluntary appeal in order. Deadlines vary from company to company. However, in nearly every instance, you will have less than 180 days to make your voluntary appeal. If this appeal is denied, or if the insurance provider does not allow for second appeals, you can take your case to court.

Skilled Guidance Through This Process Is Available

A long-term disability is challenging enough on its own. You shouldn’t have to worry about finding your way through a complex legal process as well. A skilled legal professional can help guide you through this process and help you put together a strong claim for the benefits you need.

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