Long-term disability insurance is a valuable addition to an employee’s benefits. Many people don’t consider the possibility of becoming unable to work during their prime earning years, as it is common to take one’s health for granted. As such, many people with dependent family members may not carry any form of private long-term disability insurance coverage.
When their employer provides them with coverage, they have financial protection in the event of some kind of medical emergency. Long-term disability insurance can help replace lost wages when the professional becomes incapable of working due to medical challenges. Policies provided as an employment benefit are subject to the rules established in the Employee Retirement Income Security Act of 1974 (ERISA).
Under ERISA, those denied benefits when they file a claim have the right to an appeal. They can ask the insurance company to review their claim and reconsider the determination. What does the appeals process involve?
Applicants can address issues
When rejecting a claim, the insurance company may inform the policyholder of the reason. Perhaps there was insufficient medical documentation, or maybe there were errors in the paperwork. The party appealing has the opportunity to correct those issues by gathering more medical evidence and correcting paperwork errors.
In fact, they can retain legal assistance during the appeals process to increase their chances of success. The insurance company generally has to handle an ERISA-governed disability benefits claim carefully. The company has a fiduciary duty to the policyholder, which means that their best interests should take priority over the company’s profit margins.
Appeals can lead to litigation
ERISA technically only ensures the right to appeal once. If the insurance company decides against the applicant during the appeal, then litigation might be necessary. A civil lawsuit could lead to the courts ruling that the insurance company violated the policyholder’s rights and unfairly denied their claim. Typically, litigation relies on the evidence submitted during the application and appeals process.
Those relying on long-term disability benefits as their last line of financial defense may feel more confident if they have support throughout the appeals process. Reviewing a policy and medical records with a legal professional can help people more effectively navigate a denied long-term disability insurance claim.