The Employee Retirement Income Security Act, or ERISA, is a federal law governing insurance claims that are made through employer-sponsored benefit plans. If your rightful disability claim was wrongfully denied, you may have rights under ERISA.
But what is the process for making an ERISA disability claim and appealing a denied claim?
The first step in making a claim is to ask the insurance company or your human resources department for a copy of the claim procedure. They are required to send you a copy of this procedure in writing, free of charge.
Then, following this procedure, you file your claim. The types are urgent care, preservice, postservice and disability. After you have filed your claim, the insurance company may request additional information so it can approve or deny your claim. It will inform you of a deadline for the additional information. Be sure to send in the information before the deadline. The time frame for decisions varies depending on the type of your claim.
Your insurance company either approves or denies your claim. Denying a claim must be done in writing. If your claim is denied, you have the right to appeal. In the letter denying your claim will be a specific reason for the denial, a deadline for appeal and information on how to appeal. Save this letter.
Once you have filed your appeal, the insurance company will review your appeal and either approve or deny it. You should receive notice of approval or denial in writing. The timeline for reviewing your appeal will vary depending on the original claim type.
If your appeal is denied, you can still appeal the claim through the U.S. Department of Labor Employee Benefits Security Administration (EBSA).
At each step in the process, you will need to present evidence that your claim is legitimate. This is generally a doctor’s opinion and treatment records. A lawyer can help you figure out what evidence would be persuasive in your claim or appeal.
If your claim under and employer-sponsored benefit plan such as a disability insurance policy has been denied, you may find it helpful to discuss your situation with an attorney experienced in ERISA disability claims.