Some individuals count on long-term disability policies to provide them with benefits if they are unable to work. Unfortunately, these are sometimes very difficult to obtain because they might be covered by the Employee Retirement Income Security Act of 1974.
Not all long-term disability policies are governed by ERISA. It only applies to those who have the policies through their employers. Individuals who purchase policies through private means won’t have to worry about ERISA.
Unfortunately, people who need to obtain benefits from a policy that’s subjected to ERISA may find that what should be a simple process suddenly becomes very complicated. The law sets strict time limits for the decision of these cases, but it allows a great leeway for the insurer to deny claims. Unlike some other policy types, the ones that are covered by ERISA have very limited options for pursuing an appeal.
In short, the company reviews its own decision in the first part of the appeal. Only when the initial decision is upheld on an appeal are you able to file a lawsuit to try to get the benefits you deserve. The judge who oversees the lawsuit is also very limited in what they can do. The only thing that is reviewable in an ERISA case is whether there is an abuse of discretion.
You can’t provide documents to the judge. Instead, the decision of the court is based solely on the documents that are within your insurance file. For this reason, providing as much documentation to the insurance company as you can is important if you have a long-term disability policy through your employer. These cases are complicated so working with someone who is familiar with ERISA matters is crucial.