Individuals with long-term disability insurance provided by their employers usually don’t need to use this coverage. Only a tiny percentage of those who carry such coverage may apply for benefits after incurring an injury, getting diagnosed with a debilitating illness or experiencing a major medical event.
Long-term disability insurance benefits help protect people who find themselves suddenly unable to work and therefore without income due to debilitating medical conditions. Long-term disability insurance benefits offered as part of a compensation package from an employer are subject to rules established by the Employee Retirement Income Security Act (ERISA).
Those federal rules help protect the rights of workers who may file a claim for benefits. Can someone appeal a decision to reject or deny their benefits claim if they have ERISA long-term disability benefits?
Yes, applicants should receive one appeal
ERISA extends numerous legal protections to those who need long-term disability benefits because they cannot work for an extended period. The law requires that plan administrators process claims while subject to a fiduciary duty to policyholders. Essentially, the best interests of the policyholders should come before other interests, such as the financial interests of an insurance company.
Additionally, ERISA guarantees the right to a single internal appeal with the insurance provider. If that appeal is not successful, the applicant may have the opportunity to file a lawsuit to get their benefits. Typically, the litigation process relies on the evidence submitted during an appeal, which makes the appeals process crucial to an applicant’s long-term chances of securing coverage.
Understanding rights protected under ERISA can help individuals secure the benefits they need when they can no longer work for qualifying reasons.