Many people in New Jersey have short- and long-term disability coverage as a benefit through their employers. These types of benefits are covered by the Employee Retirement Income Security Act of 1974. As an ERISA-covered benefit plan, an employer-provided benefit plan must comply with the regulations under the law.
While ERISA applies to employer-provided disability plans, it does not apply to private disability insurance. The law requires that employers notify their employees about what the insurance covers, how to file claims, and how to file an appeal if a claim for benefits is denied. Under ERISA, an insurance company must decide whether to accept or deny a claim within 45 days of when the claim is filed. However, the company can extend this period by 30 days upon providing notice to the claimant.
If a claim is denied, the employee will have a deadline for filing an appeal. People must exhaust the internal appeals process of the insurance provider before they can file lawsuits under ERISA. An insurance provider may have several levels of internal appeals within the company. Claimants can supplement their records while they are still being processed through the internal appeals process. Once the internal process is exhausted, they can then file lawsuits in court.
People who receive denial notices from their employer-provided disability insurance after they have filed claims should pay careful attention to the letters they receive. They will contain information about how to file an appeal and the deadline for doing so. Because the appeals process can be complex, people may benefit from getting help from an experienced ERISA attorney. A lawyer might review the reason for denial and the contents of the file of evidence that the company used to reach its denial decision. He or she may then help his or her client to supplement the record to increase the likelihood of succeeding on the appeal.
