Whether your employer provided a long-term disability insurance policy in your benefits package or you opted in to a group policy and have been paying the premiums yourself, you should be able to count on it to help you get by if you become unable to work due to an illness or injury. However, the truth is that these claims—even entirely legitimate ones—are routinely denied by the insurance company. Why is that? Often it’s simply because they can get away with it. To file a successful claim, you need to understand your rights, which means understanding the federal law that is supposed to be safeguarding your rights.
What Is ERISA?
ERISA stands for the Employee Retirement Income Security Act. It was signed into law by President Gerald Ford in 1974 to protect employee pension funds but has been revised over the years to include provisions about group long-term disability insurance policies.
While the original intent of the act was to protect workers, in practice, the law heavily favors insurance companies. The law grants workers the right to appeal a denial of an LTD claim and to take the case to federal court if the appeal is denied. While these can prove strong protections, you will need an attorney to help you navigate the complicated process—and few attorneys will take these federal cases.
Attorney Jim Monast Welcomes Your ERISA Claim
Monast Law Office has been representing Ohioans in workers’ compensation claims and appeals for over 30 years. Attorney Jim Monast and his team know their way around a disability claim. If a chronic or terminal illness, debilitating injury, or other impairment prevents you from working and you were denied the long-term disability benefits you deserve, they can help you meet the restrictive standards set by ERISA to improve your odds of a successful appeal.
Why LTD Benefits Are Often Denied
The insurance industry only works if it collects more money in premiums than it pays out in benefits. The less it pays out, the richer the executives get. This is true with every kind of insurance, including long-term disability policies.
Adjusters will look for any reason to deny your claim, but the most common reasons are:
- Missed deadlines. Your policy will limit the time you have to file for disability initially, as well as the time you have to file an appeal. People often miss deadlines as they see doctors, try to get better, and attempt to understand their coverage and how to apply. Usually, you have only 180 days to file an appeal after a denial—a deadline many people fail to make.
- Lack of medical evidence. You must submit significant medical evidence to prove that you are disabled and that you cannot perform the tasks your job requires. Applicants often fail to understand what kind of documents and reports they need to collect and submit.
- Disability definition. Every LTD policy is different, and your doctor’s assessment of a disability may not meet the standards spelled out in your policy. You must read and understand the small print in your policy to make sure you meet their definition of a disability.
Understanding your policy before you need to file a claim is a good way to be prepared if you need to file one day.
How ERISA Works Against Employees
Even though ERISA was initially enacted to protect employees, the provisions regarding LTD insurance actually favor the insurance companies. While you are granted the right to appeal and to go to court, ERISA makes it difficult with these restrictions:
- You are only allowed one appeal.
- The deadlines are short and very strict.
- Your appeal is heard by the insurance company, not an impartial court or board.
- While you can sue if your appeal is denied, you cannot introduce new evidence or choose your court.
- Even if a judge agrees with you, you have to prove that the insurance company acted unreasonably in denying your claim—an extremely high standard to meet.
Because these cases are complicated and time-consuming, it is nearly impossible for a layperson to succeed in getting their claim approved. Very few attorneys will take ERISA cases for the same reasons.
Talk to Monast Law Office About Your LTD Appeal
Trusted workers’ comp attorney Jim Monast is dedicated to providing injured workers with the guidance and representation they need to get the long-term disability benefits they deserve. Contact our office in Columbus to discover how we can help!