Most working professionals don’t spend much time thinking about disability. People operate under the assumption that they can maintain their health indefinitely or at least until well into their retirement years. Unfortunately, a small percentage of individuals experience medical issues that force them to cease working earlier than they planned.
Some professionals may have employer-sponsored disability benefits to help in that difficult situation. Companies may offer benefits packages that include long-term and short-term disability benefits. Should a worker become unable to do their job, they can qualify for payments that replace their wages.
These private benefits are often better than federal benefit programs that offer minimal support. However, workers may still have challenges when applying for long-term disability benefits provided by their employers. An insurance company could reject a qualified applicant who cannot work.
Can those facing a rejected initial application appeal?
The law protects the right to appeal
Disability benefits provided by employers are subject to federal regulations. The Employee Retirement Income Security Act of 1974 (ERISA) is one of the most important laws that may apply. Under ERISA, workers have certain baseline protections for benefits that affect their health and financial well-being.
In a disability benefits case, ERISA requires that the insurance company uphold the policy in good faith and act in the best interests of the policyholder. Should the policyholder file a claim and the company deny that claim for benefits, the policyholder has a right to appeal.
ERISA provides for one internal appeal overseen by the insurance company. That appeals process is crucial. Applicants need to appeal quickly and must submit adequate documentation to confirm their claim that they should receive disability benefits.
Appeals can often prove successful when applicants have the right support and evidence. If the appeal is not successful, they may have the option of litigating to seek benefits. During the litigation process, the evidence submitted during the initial claim and the appeal becomes the evidence that the courts consider.
Those facing an ERISA long-term disability benefits claim or appeal may need help throughout that process to optimize their chances of success. Retaining assistance as soon as the claims process becomes complicated could improve a worker’s chances of getting the disability benefits they need while they are unable to work.