ERISA Traps

Unfortunately, ERISA is a very complicated statute and there are many technicalities that can prevent a policyholder from ever having a chance to correct an erroneous denial of benefits. Once an ERISA long-term disability insurance claim is denied, there is always an appeal available to seek reconsideration. These appeals rarely result in the payment of a claim but are critical in the event a lawsuit is necessary in order to obtain benefits. It is important to consult an ERISA long-term disability insurance attorney to assist in handling an appeal.

There are several things that you should consider:

Ordinarily, you must appeal if you are given the right to do so. Failure to appeal in most circumstances will mean that you will never receive your benefits.

Ask for your entire file from the insurance company. You have an absolute right to have a copy sent to you at no charge.

Ask for a complete copy of the insurance policy.

Ask for any procedures or guidelines that were applicable to your long-term disability insurance claim.

Take the time deadlines seriously. Failure to comply with time guidelines may result in a complete waiver of the right to appeal.

If you have to sue the insurance company, in most circumstances, the only evidence the court may be permitted to look at is the information that you and others send to the insurance company during your appeal. Therefore, it is important to send all pertinent and supporting information.

It is unlikely that the state Department of Insurance or the Department of Labor will be able to give you any significant help.

It is unlikely that your employer will be able to give you any significant help either.

To learn more, please contact an attorney at Nelson Langer Engle, PLLC.