The Employee Retirement Income Security Act (ERISA) gives you rights when you are denied benefits from an employer-sponsored benefit plan. Although it applies to a variety of benefits, an extremely common benefit to be denied is long-term disability insurance.
Long-term disability insurance typically picks up where short-term disability insurance ends. It is supposed to kick in when a physical or mental health condition makes it impossible for you to work. Depending on your policy, this may mean it’s impossible to work in your own profession, or that it’s impossible to work at all.
Long-term disability insurance is therefore a crucial and vital protection for working people. Unfortunately, legitimate claims are denied all too frequently. The good news is that you can appeal a denied claim. The not-so-good news is that the process is technical and somewhat daunting. Hiring an attorney who specifically handles ERISA appeals may increase your chances of appealing successfully.
First steps to appealing a denied long-term disability claim
Understand your policy. In order to understand your policy, you will need to get a copy. Since we’re talking about an employer-sponsored benefit, you should be able to get a copy from your employer’s human resources department.
If that doesn’t work, ERISA requires the plan administrator at your long-term disability insurance company to provide you with a copy of all plan documents. If you request it from your insurance company, be sure to send the request via certified mail and request a return receipt.
Understand the reason for the denial. The letter sent to deny your claim should contain specific information about why your claim was denied. It should also spell out the procedure for appealing. Take special care to note the deadline for your appeal. Missing this deadline will make it very difficult or impossible to appeal successfully.
Often enough, the reason for a claim being denied is that insufficient evidence was provided in the claim. It may be obvious what evidence is missing, and it may already exist. If the issue is a simple matter of missing medical records, you can track them down and send them in as part of your appeal.
If all your relevant medical records were considered by the company, you may need additional evidence. This might include additional medical tests to confirm your diagnosis or to dispel a misunderstanding. It might include a written opinion by a doctor. Or, it might be the opinion of a vocational expert who can confirm that you are fully disabled from working.
If you are unsure why your claim was denied or what evidence might be appropriate for an appeal, be sure to work with an experienced ERISA lawyer.