Long-Term Disability Insurance Claim Denied? When to Talk to an ERISA Attorney

Talking to an attorney about an ERISA claimYou may have never seen the acronym ERISA before, but if you have long-term disability (LTD) insurance through your employer and your claim was denied, you need to know what this term means and why you need an attorney who accepts these kinds of cases.

I've helped injured workers in Ohio with workers’ compensation claims for over 30 years, but I also accept long-term disability ERISA claims.

Find out why it’s vital for you to work with an attorney if your LTD claim was denied.

What Is ERISA?

First, a little background. ERISA stands for the Employee Retirement Income Security Act, a federal law enacted in 1974. It was initially intended to protect employee pensions and retirement savings but has expanded over the decades to encompass almost all private employee benefit plans, including company stock benefits, life insurance plans, vacation and sick leave, healthcare, and disability insurance.

If you work for the government or a school district, your benefits probably aren't covered by ERISA. The law is supposed to help employees get the benefits to which they're entitled, in part by granting the right to appeal a denial of benefits. However, ERISA’s appeal process is complicated and cumbersome, making it difficult for an employee to be successful without the help of an attorney.

When to Call an ERISA Attorney

While ERISA claims can be made in federal court for mismanagement or denial of any employee benefit, in my practice, I deal specifically with denials of long-term disability benefits. If you opted into the LTD plan that was included in your employee benefits package, you probably believed you'd be covered if you became unable to work.

However, now that you're in that situation, your claim for LTD benefits was denied. Thanks to ERISA, you have the right to appeal this denial, but, also thanks to ERISA, it's a complicated process. I can’t stress enough the importance of talking to a disability attorney who takes ERISA cases and can help you:

  • Determine the due date. Deadlines for ERISA appeals are strictly observed, so you must file your complete appeal before the due date.
  • Request documents from your employer. You only get one chance to submit all the necessary documents to support your appeal, so it's critical to get your entire claim file and any other related documents from your employer. An experienced ERISA attorney will comb through all this paperwork to look for mistakes that help your appeal.
  • Examine the insurance company’s process. You can only win an ERISA appeal if you can prove that the insurance company made an error or acted in an unreasonable manner. This isn't something a layperson can accomplish alone.
  • Look for other inconsistencies. Your ERISA attorney examines everything in your claim file—including testimony from experts, medical records, and video surveillance—to find inconsistencies or mistakes. If there's any indication that your claim was mismanaged, you'll have a strong case for appeal.
  • File a detailed appeal on time. If you win an appeal, you'll be able to file a lawsuit in federal court, but not enter any new evidence, so this initial appeal must include every piece of evidence and present a convincing argument that you were denied unfairly.

Are you required to have an attorney to file an appeal? No, but the likelihood of success without one is slim. It takes a lot of legwork and a thorough understanding of ERISA law to put together a persuasive appeal.

Talk to Monast Law Office About Your LTD Appeal

For over 30 years, I've dedicated my focus to provide injured workers with the guidance and representation they need to get the disability benefits they deserve. Contact our office in Columbus to see if we can help you! 

 

James Monast
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Fighting for Ohio’s Injured Workers and their Families