Many people understand the long term disability (LTD) benefits they receive through work are there to guard against the unexpected. While this is a prudent way to protect one's income in the event of a debilitating injury or illness, many underestimate the difficulties surrounding the collection of LTD benefits.
Most benefits received through work, like health, disability and life insurance are governed by a federal law called the Employment Retirement Income Security Act, or ERISA. ERISA is a very complicated area of law that is full of unforgiving traps for the unwary. ERISA severely restricts the remedies available to claimants who are wrongly denied benefits. Because of the unique procedural rules of ERISA, seemingly benign mistakes can result in destroying your opportunity to receive disability benefits.
This post will highlight some of the common pitfalls ERISA claimants may encounter and what to do about them.
Failing to provide adequate evidence - As we noted in our prior post, failing to provide objective medical findings may result in an insurer denying your claim. But when appealing an initial denial, it is critical to provide exhaustive supplemental evidence to support your position.
Failing to Obtain your Claim File Documents - ERISA requires insurance carriers to provide claimants with their entire claim file - all the documents and communications (good, bad and ugly) relevant to your claim for benefits. Obtaining the claim file can help identify the gaps in the evidence or the narrative the insurer has deployed to deny or terminate the claim. Failing to address the key aspects of the denial may doom your claim.
Not knowing the limitations of an appeal - Some policies provide the option for one appeal and some permit a second, voluntary appeal. However, all ERISA-governed policies require claimants to submit an administrative appeal before filing a lawsuit for your benefits. Many claimants fail to realize that a lawsuit in federal court may be limited to the evidence that was submitted to the insurer through the appeal process. This is why it is so important to have the help of a legal advocate with a specialty in ERISA.
Insurers will take advantage of your unfamiliarity with ERISA, but you can level the playing field by having an experienced disability law attorney at your side. If you have questions about how ERISA governs your rights to LTD benefits, we invite you to contact us.