Under federal law, the Employee Retirement Income Security Act of 1974 ensures that private employers provide their workers with an adequate retirement plan. While this is ERISA’s main purpose, its provisions also extend into other benefits that employees are entitled to.
For those who receive coverage from an insurance plan sponsored by their employer, understanding how ERISA protects you and what it requires is an essential part of protecting your rights. ERISA does not apply to disability insurance plans that are bought separately from an employer’s benefits package.
Employers are required to provide the following information to their employees regarding their disability benefits:
- A layout of things that are and are not covered
- Instructions for filing claims
- Instructions for appealing denied claims
Follow guidelines carefully to avoid claim denial
Insurance providers are given a 45-day deadline to accept or deny after an employee files their claim. In some cases, the provider may notify the worker and extend the deadline by up to 30 days.
In the event of a denied ERISA disability claim, your employer is required to give a written explanation of their reasoning. There are strict deadlines that ERISA sets for both appealing the denial as well as the insurance company approving or denying the appeal.
It’s crucial that you follow every step in this often complex process carefully. The sad truth is that many ERISA disability claims are denied due to applicant error. This makes it highly advisable to take your time researching and may be worth it to seek out professional guidance.
In the event that an applicant shows that they’ve followed all of ERISA’s guidelines and still had their appeal denied, it may be a suitable time to take legal action against the insurance provider. If a lawsuit is filed against an insurance plan provided by an employer, a judge will review the case for abuse of discretion.