ERISA Long Term Disability Claims And Appeals Processes: Overview

The Employee Retirement Income Security Act (ERISA) was enacted by Congress in 1974 to allow workers to participate in government-backed retirement and disability plans. While the motivation behind the Act was to improve workers’ economic well-being, employees today find that ERISA disability plans are often difficult to navigate, and that denials of claims are hard to contest. Indeed, even a minor error in the initial claims process could significantly delay, if not entirely derail, a disability claim. At Hiller, PC, our NY disability insurance lawyers can assist you through the complicated ERISA claims and appeals process.

Understanding the Summary Plan Description

The key to understanding your employer-sponsored disability insurance is the Summary Plan Description (SPD), which provides an overview of the plan. Before filing a claim, consult with your disability insurance lawyers to make sure you understand your plan and determine if you have a covered claim.


The Claim Review Process

ERISA provides that long term disability claims must be evaluated and ruled on within a reasonable period of time, but not later than 45 days from receipt of the claim.  Under certain circumstances, the insurer or plan administrator can request up to two 30 day extensions of their deadline to render a decision on your disability claim — for a total of 105 days.  During this time, your insurance company will likely ask for additional information from you.  Since this back-and-forth process can cause significant administrative delay, during which time you may have no ability to work and earn an income, it can be quite detrimental to you. It is, therefore, important that your initial claim be comprehensive, comply with ERISA filing requirements, and provide adequate supporting documentation. Working with your NY disability insurance lawyer to prepare your claim will help you avoid any needless delay.

The Appeal Process

Should your disability claim be denied, any appeal must be made through ERISA’s administrative appeal process, which could require two levels of review. Once your appeal is filed, your insurance company has 45 days to make a decision, but they can request a 45 day extension if special circumstances exist that prevent it from deciding your appeal on time.  If your administrative appeal is unsuccessful, your final recourse is to file a court action seeking disability benefits. At Hiller, PC, our New York disability insurance lawyers work hard to get your benefits approved without the need to go to court. We know from experience that although litigation may sometimes lead to a buy-out or lump-sum payment, more often than not it serves only to delay payment of benefits. Consequently, we take an “everything plus the kitchen sink” approach to your administrative appeal. We gather all relevant evidence, and craft a detailed and comprehensive appeal that plainly demonstrates your right to benefits. This strategy is highly effective; in almost every appeal we handle, our client is awarded benefits.

Contact Our NY disability insurance lawyer For Help With Your ERISA Claim Or Appeal