The Employee Retirement Income Security Act or ERISA governs employee benefits, such as long-term disability plans. Contrary to its original purpose, many purport that ERISA actually protects insurers more than it does claimants. To determine whether the law applies to your policy, you must establish where you purchase your policy. If you obtained it from a private insurer, state laws likely govern your policy; if it is an employer-provided policy, ERISA applies.
Should a provider deny your ERISA disability claims, you can file an appeal. Learn common reasons for denial and the steps to take if it happens to you.
Review Your Policy
Your policy provider determines the precise appeal process you must follow, so it is imperative that you read, understand and abide by the terms laid out in your long-term disability insurance policy. If you do not have your own copy, request one from your human resources department. Request a copy of the policy in writing directly from the insurance administrator if your HR administrator fails to provide one to you.
Assess the Denial Letter
Carefully reading the points made in the letter notifying you that the provider has denied your claim will help you prepare for your appeal. This letter may also stipulate forms, documents or deadlines you must provide in order to file an appeal successfully as well phone numbers, email addresses and mailing addresses you may need.
Begin compiling the information you need right away. You may need to track down missing documents that medical providers never submitted or make multiple requests for files and reports. Scheduling appointments with specialists can take weeks or even months, so if you require further testing or medical confirmation for your appeal, you should make those calls immediately.
Refer to both your policy and your denial letter to find out the final dates by which you must submit documents, file official forms or request a hearing. If you contact the insurance provider for further information, be sure to document the date of your call or email, the name of the person with whom you spoke and precise details of your conversation.
Obtain Professional Assistance
If you feel overwhelmed by the appeal process or your health makes it difficult for you to take action, consider seeking the help of an attorney. A lawyer who specializes in long-term disability cases can help you obtain the benefits you deserve more quickly and with less difficulty.Share