The Employee Retirement Income Security Act (ERISA) is a federal law that focuses mostly on retirement plans in Hackensack, New Jersey. However, it also affects employee benefits and disability insurance plans.
How does ERISA affect disability benefits?
ERISA only applies to disability benefits an employer provides as part of a benefits package. It does not apply to privately bought disability insurance. Under ERISA, employers must inform their employees about their disability package. Some of the information that an employer must provide include what gets covered by the package, how to file a disability claim if an employee becomes disabled, and how the appeals process works if a claim gets denied.
Does ERISA have a time limit?
ERISA has a time limit for when the insurance provider must decide whether to deny or approve a claim. Under most circumstances, the insurance company must make this decision within 45 days. However, under certain special circumstances, this time limit can get extended by an extra month. If the insurance provider denies the claim, it must explain the reason for denying it in writing. Much like the insurance provider time limit, there is also a time limit for the appeals process. This time limit is also 45 days.
How does the appeals process end with ERISA?
If an appeal gets denied, and a worker has followed all ERISA guidelines, he or she can then sue for an “abuse of discretion.” This means that the judge’s ability to make an accurate decision gets questioned. In this lawsuit, the judge will look at the insurance company’s policy when deciding how the case will turn out. For this part of the case, it is important that an employee show documentation related to the disability, such as medical reports or employer notes.
ERISA comes with many guidelines to follow and a complicated claims process for noncompliance. To make the most out of ERISA for your disability claim, you must carefully document any doctor visits or employer notes. A disability lawyer could help navigate the complicated and strict ERISA claim process.