ERISA disability claims are unique. They follow a different structure from most insurance claims, and for that reason, it is important to understand how they work or risk losing benefits.
Consideration of Your Claim
ERISA benefit claims involve a review process by the insurance company. The administrator is the company or person who actually makes the decision to deny or pay benefits. If the plan is insured, it is often the insurance company. If the plan is self-funded (i.e., not insured), there’s often a committee of employees or a third-party administrator ( a “TPA) that makes the decisions.
If the administrator denies your claim, there is a process to seek reconsideration of the decision. Do not try to handle this internal appeal on your own. Contact an attorney who could handle ERISA disability claim denials or terminations anywhere in the country.
The Administrative Review Process
ERISA requires plans to provide a fair review process when they deny or terminate long-term disability benefits. This step is crucial and could lead to a reversal of the decision if handled properly.
An ERISA attorney could first review the denial notification to learn the specific reason the plan cited to deny your benefits. The plan must be transparent about why it denied your claim.
A legal professional could compile medical records, vocational studies, and other evidence that supports your claim and directly addresses the plan’s stated reasons for denial. If the internal review does not succeed, this record forms the basis for a lawsuit seeking your benefits.
