What is an adverse benefit decision on a long-term disability claim?

If you file a long-term disability (LTD) claim on your employer-sponsored policy and the insurance company denies or terminates your application, pays less than the claim is worth or says you're only entitled to limited benefits, that means they have issued an “adverse benefit decision.” As soon as this happens, you have necessary rights to act on.

But unless you talk to an attorney who handles ERISA claims, you'll have a hard time exercising those rights. Let me explain what I’m talking about.

ERISA Grants You This Important Right

The Employee Retirement Income Security Act (ERISA) is a complicated piece of legislation that protects both employers and employees in situations involving various kinds of benefits, including long-term disability insurance policies. Under ERISA, if you receive an adverse benefits decision, you may get a copy of your claim file to see the information the insurance company used to make the adverse decision.

Now, it won’t just voluntarily hand over the claim file. You'll have to request it in writing and, even though the carrier is required by law to give you the record, it might still deny your request.

How Can You Protect Your Rights?

Maybe the claim manager isn't aware of the law that compels the company to hand over the file, or it could be more intentional than that. Either way, without an ERISA attorney advocating for you, it's unlikely you'll get access to the file, even though the law is on your side. Even if you're able to get the file, it will be difficult, if not impossible, for you to wade through the data and figure out if you have a case for an appeal.

However, an experienced ERISA attorney such as myself has the knowledge and resources to review the file—which could be thousands of pages long—and determine if you have reason to appeal.

Trust Monast Law Office With Your LTD Appeal

As I said before, ERISA protects both you and your employer. While it might grant you some rights, it also limits what you can do with those rights to protect the employer. Your best bet is to call our office when your LTD claim is underpaid or denied. Leave the complicated ERISA laws to us—we’ll make sure your rights are protected. If you want to learn more about ERISA, request a copy of our free book, How Insurance Companies Sabotage Disability Claims.