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Long-term disability denials and appeals under ERISA

| Jul 30, 2020 | Uncategorized |

Many Pennsylvanians are offered long-term disability as an optional employer-provided benefit. When people have long-term disability insurance through their jobs, their benefits plans are covered by the Employee Retirement Income Security Act. Plans that are covered by ERISA must comply with the requirements of the law.

Workers who have long-term disability insurance through their jobs may be shocked when their claims are denied. Long-term disability insurance is designed to replace a percentage of a worker’s income while he or she is disabled and unable to return to work. The benefits may be available after a waiting period of up to 180 days for two years, five years, 10 years, or until retirement, depending on the provisions of the plan.

When a claim for long-term disability benefits is denied, the plan must provide the worker with a letter listing the reasons for the decision. Workers have the right to appeal a denial decision. However, before a lawsuit can be filed against the employer and long-term disability insurance provider in court, the claimant must first exhaust the insurance company’s internal appeals. Companies may have one or two levels of internal appeals in their process. Many people are able to resolve their claims during the internal appeals process to receive their benefits. They might need to submit more evidence to their claims files to support the reasons why their claims should be approved.

People who have received denials of their long-term disability claims may want to consult with experienced ERISA attorneys about the appeals process. An attorney might help the client to meet all of the deadlines for the appeal and to gather additional documentation that may be needed to support the claim.