Frequently Asked Questions About ERISA Benefits
Insurance claims and appeals can be difficult to navigate without extensive legal or financial training. However, if you find yourself facing the daily challenges of a disability, it is critical to know how to file a claim and get the benefits you need. Willeford & Toledano can give you clear information and help you move forward.
Which policies are covered under the Employee Retirement Income Security Act (ERISA)?
As a federal law, ERISA applies to most private employers who offer retirement and certain health benefit plans to their employees, such as long-term disability and short-term disability insurance. ERISA does not apply to government employers or private disability insurance purchased by individuals. Employees of all rankings — from custodial staff to welders to C-suite executives — may have a policy covered by ERISA.
How does ERISA affect my insurance claim?
ERISA sets rules for the process of filing a claim, denying a claim, appealing a claim and more. As a worker with a qualifying policy, you benefit from disclosure requirements about your policy and rights, protection against discrimination, clear and timely rationale for any denied claim, options for appealing claim denial and more. However, ERISA laws are highly favorable to insurers, and policyholders have limited rights, so legal counsel is critical in these cases.
What should I do if I have questions about my disability claim?
Filing a claim is a complex process. It is better to seek help for your claim rather than sacrifice your opportunity to get benefits. An attorney who has in-depth experience with ERISA claims can help you prepare your application and answer any questions you may have. Your lawyer can also strengthen your claim to have the highest chance of getting approval without the hassle of the claims appeal process or litigation.
I have a new disability and my claim was denied. What can I do now?
When you receive notification from your plan provider that they have rejected your disability claim, it is advisable to contact your attorney. You have an opportunity to appeal their decision under ERISA. A strong appeal typically requires additional medical evidence, documentation and other tasks related to your case file that your attorney can help you complete.
How long do I have to appeal a claim denial?
Under ERISA, you have 180 days from the claim denial to pursue your appeal. Although this period may seem like a long time, a strong appeal will need plenty of time to prepare. Starting the appeals process as early as possible is critical.