You may assume that you could easily apply for, and receive, your employer-provided insurance benefits — until you actually attempt to do so. Unfortunately, the federally enacted Employee Retirement Security Act (ERISA) unintentionally created obstacles for employees attempting to claim ERISA insurance benefits. A Columbus ERISA lawyer can help you navigate the claim and appeal process, thus increasing your chances of success.
The ERISA was intended to increase protections for employee pensions and employer-funded benefits, such as:
Instead, due to the strict claims and procedures, ERISA created numerous challenges for injured employees claiming insurance benefits. The ERISA unintentionally gave increased power to insurance companies who have the authority to determine the outcome of insurance claims.
ERISA only applies to employer-provided insurance claims. Personal and other non-ERISA insurance plans are subject to state rules and laws. A Columbus ERISA lawyer can review your claim and educate you regarding applicable procedures and laws.
ERISA Disability Insurance Claims
ERISA requires that the claim and appeal procedures associated with your disability insurance plan are explained in writing. Thus, it is important to obtain a copy of your current Summary Plan Description (SPD) as well as your Plan Document before filing your disability insurance claim. Your employer or plan administrator – who could be your employer, an insurance company, or another third party – must provide you with both these documents.
The SPD summarizes the following:
- Claim Procedures
- Disability Benefits
- Filing Deadlines
- Appeal Process
Compared to the SPD, the Plan Document is more comprehensive.
When you submit your ERISA disability insurance claim, the administration files it with your plan administrator, who determines the outcome. It is critical, then, that you comply with the filing deadlines and claims procedures or you risk losing your benefits. To increase your chances of success, you should submit detailed evidence in support of your claim. Do no rely on your plan administrator to conduct a thorough investigation. You are responsible for providing all evidence supporting your claim. Your Columbus ERISA lawyer can help you submit a complete disability claim package to up your chances of approval.
You will receive your benefits soon after receiving a written notice of approval. Keep the written notice denying your claim because it details why you were denied and explains the appeal process.
Appeal a Denied ERISA Disability Claim
You can appeal your denied ERISA disability claim by:
- Submitting an administrative appeal with your plan administrator
- Adhering to the strict appeal procedures
- Providing any additional or missing supporting evidence
You could also file a federal lawsuit, but only after your appeal is denied and you “exhausted all of your administrative remedies.”
Your Columbus ERISA lawyer will help you comply to the strict appeal deadlines and other requirements.
ERISA Life Insurance Claims
You may be entitled to your deceased loved one’s employer-funded life insurance benefits. There are strict requirements to claim those benefits, which are frequently denied because of:
- Issues over beneficiaries,
- Nondisclosure or misrepresentation, or
- Issues regarding eligibility as defined in the Plan Document, like ineligibility because of suicide or illegal drug use.
Don’t despair if your initial claim is denied. An experienced Columbus ERISA lawyer can review the eligibility requirements and help you recover the benefits you deserve.
ERISA Accidental Death and Dismemberment Insurance Claims
Employer provided AD&D applies if the employee’s death or severe injury is the result of an accident, as opposed to a “non-accident” or an illness. A knowledgeable lawyer can evaluate your AD&D policy and educate you on your rights.
Non-ERISA Long Term Disability Insurance Claims
You may have a private or independent long term disability insurance (LTD) that is not provided by your employer. Although not subject to ERISA, it may still be difficult to obtain LTD benefits. Insurance companies often deny even the valid LTD claims. After reviewing your policy, a Columbus ERISA lawyer can assess your eligibility, evaluate your medical evidence, and help you navigate the claims or appeals process. This includes helping you compile supporting objective evidence that, depending on you policy, evidences your inability to perform your job, or any job.
Bad Faith Insurance Claims
You could have a valid bad faith claim if your insurance company fails in its duty to both fairly and neutrally evaluate your insurance benefits claim. You could also be entitled to punitive damages if the underlying insurance benefits claim is not subject to ERISA. Punitive damages are not allowed in bad faith claims under the ERISA. Our experienced lawyer can investigate your bad faith claim and help you reach the outcome you deserve.
Contact a Columbus ERISA Lawyer
Whether it’s filing a claim or an appeal to obtain ERISA or non-ERISA insurance benefits, your chances of success increases with a seasoned Columbus ERISA lawyer by your side. Call J. Price McNamara for a free consultation at 504-458-8455 today.