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When your employer offers disability insurance as a benefit, the plan is governed by a federal law called the Employee Retirement Income Security Act (ERISA). The law requires the plan to meet specific requirements, including rules concerning applying for benefits and appealing unfavorable decisions.
The experienced ERISA attorneys at Cody Allison & Associates are knowledgeable about the ERISA disability application process in Nashville. We can help you apply for benefits regardless of where you reside.
When a private company offers disability benefits, the administration of the plan is handled in one of two ways: through an insurance company or the employer self-insures and administers the plan. Our Nashville-based attorneys can advocate for you regardless of who administers your employer’s ERISA disability plan, nationwide.
Most companies buy a disability plan from an insurance company and offer it to their workers as an employment benefit. The insurance company administers the plan and makes coverage decisions.
Some larger employers self-insure, which means the company funds the benefits and manages the plan. Many hire a third-party administrator (TPA) to handle claims and compliance issues, though ERISA does not require this. Whoever administers the plan has a fiduciary duty to act in the best interests of the plan participants.
When you become disabled, requesting your disability policy is a crucial first step. The policy will explain your benefits, deadlines, and the application and appeals process. It will also contain the definition of disability that applies in your case.
These definitions are not standardized and can vary between policies. Knowing the definition your carrier will apply to your case is essential.
An ERISA attorney at our firm in Nashville will review the policy to determine the supporting documentation your disability carrier will require. This will include your medical records and forms that you, your doctor, and your employer must complete. If any of these forms is inaccurate or your application is incomplete, your claim may be denied.
Your application for benefits must demonstrate that your disability prevents you from working. Insurance companies usually distinguish between not being able to work at your occupation and not being healthy enough to work at all. Many policies will provide you with benefits for a period when your records show you cannot work in your occupation, but will eventually terminate your benefits, claiming that you are able to perform other jobs.
If your initial application is denied or if the company terminates your benefits, you are allowed an appeal under 29 U.S. Code of Federal Regulations § 2560.503-1(h)(3)(i). The information you present to support your appeal forms the basis of all further decisions in your case, so work with our experienced, Nashville-based ERISA disability attorneys to compile a thorough and compelling record on appeal.
The denial letter will state why the carrier denied your benefits, and we will develop our appeal to be responsive to the reason cited. We may seek additional medical tests and second or third opinions from highly qualified experts, including detailed narrative reports. Functional Capacity Evaluations provide critical evidence in many appeals, and reports from vocational experts can be persuasive.
If you cannot work due to injury or illness, your disability benefits provide a critical cushion. The attorneys at Cody Allison & Associates can provide valuable assistance with the ERISA disability application process in Nashville.
Although we are based in Nashville, we represent clients across the country in ERISA disability matters and offer free consultations by video call nationwide. Reach out today to learn how we can help.