Some employment benefit packages include various types of insurance. Workers may receive long-term disability coverage in addition to basic health insurance. If they experience a debilitating medical event or sustain an injury that prevents them from continuing to work, they may be able to file a claim for benefits that replace their lost income.
Long-term disability insurance policies provided by employers are subject to the rules of the Employee Retirement Income Security Act of 1974 (ERISA). The five steps below are critical for the protection of workers in need of long-term disability benefits after an unfair denial.
1. Document communications
Those dealing with inappropriate reactions from insurance providers likely need to make sure they receive all communication in writing. That way, there is evidence of their interactions with the insurance company that can help prove that they unfairly denied a valid claim.
2. Review the policy
The exact requirements imposed by a long-term disability policy differ from company to company and even policy to policy. Therefore, workers need to review the policy itself to ensure that they have followed all of the necessary procedures and that their circumstances meet the necessary standards.
3. Talk with a lawyer
Many people in need of long-term disability benefits seek out a lawyer from the earliest stages of the claims process. An attorney can manage communication with the insurance provider and assist with the review of policy documents. They can also help educate their client about their rights and navigate the majority of the legal steps necessary on the policyholder’s behalf.
4. Gather medical records
Generally speaking, ERISA extends the right for a single appeal to each policyholder. People seeking long-term disability benefits typically need to provide the insurance company with enough medical evidence to validate that they meet the necessary standard for benefits. Intensive examinations, such as functional capacity evaluations, can help validate that the condition is severe enough to prevent gainful employment and likely to persist for long enough to make benefits necessary.
5. Prepare for the possibility of litigation
If an internal appeal managed by the insurance company does not result in an approval, then the matter may need to go to court. In scenarios where insurance companies unfairly deny long-term benefits to policyholders, the people denied benefits can typically ask the courts to review the matter. The lawyer assisting with the claims and appeals process can also assist their client by preparing for litigation if necessary.
Learning more about how to pursue ERISA long-term disability benefits after an unfair denial can help people get the coverage they deserve. Professionals who cannot work often need support as they seek financial relief by claiming the coverage their employer provided to them, and that’s okay.