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What Is ERISA and How Do I File a Claim?

Many employer-sponsored short-term and long-term disability insurance plans are governed by the federal Employee Retirement Income Security Act (ERISA). ERISA regulations are in place to protect employees by establishing standards for how plan sponsors must handle benefits and claims.

Your Summary Plan Description will outline the process for filing a disability claim. If your plan is covered under ERISA, the insurance company has up to 45 days to review your claim and make a decision. If your claim is approved, they must disperse your benefits within a reasonable amount of time. However, if it is denied, they must send you written notification of their decision.

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Appealing Claim Denials or Benefit Cancellations

Under an ERISA-covered policy, if your short-term disability claim is approved, you may receive benefits for up to 6 months. After that time, it becomes a long-term disability claim. Because many companies have specific definitions of disabilities and have limitations on how long you can collect, they might terminate your benefits once you’ve reached the limit for your short-term disability claim.

If you have an ERISA policy, and your claim has been denied or you have been dropped by the insurance company, you generally have 180 days to appeal the decision. While you are preparing to submit the appeal, you must gather medical records or undergo additional diagnostic tests to substantiate your claim and demonstrate that you meet the disability requirements, as defined by your policy.

Filing a Lawsuit After an Appeal Denial

Unfortunately, the company may deny your appeal. If this happens, you can move forward with a lawsuit. The hearing for your suit is based on the Administrative Record, which is the documentation the insurance company has regarding your claim.

Schedule a Free Consultation with Goodman Acker P.C.

At Goodman Acker P.C., we are committed to helping you through the ERISA claims process. We have in-depth knowledge of this area of the law, and we will provide sound support and advice if your claim or appeal has been denied.

Call us at (248) 793-2010 or contact us onlineto discuss your case.