If you have applied for disability under your employer’s insurance plan and were denied benefits, what can you do?
The first step is to obtain a copy of your employer’s disability insurance plan.
Most policies that are offered by employers are covered under Federal ERISA Law. ERISA law requires that, before you can file a lawsuit, you must appeal the denial internally with the insurance company, in accordance with the language of your plan.
There are very stringent rules to follow regarding how the appeal is handled. The plan will have specific language regarding key questions that will form the basis for the appeal process in your case.
How much time do you have to appeal your denial?
Your plan will tell you what the deadlines are to appeal; some plans specify 60 days while most plans allow 180 days to appeal the denial. Some plans allow two appeals.
How can the insurance company say I am not disabled, when Social Security has approved my disability?
Even if you have been approved for disability benefits by the Social Security Administration, you may still be denied benefits by your employer’s group disability plan. One reason this happens is because the insurance company and the SSA do not always observe the same definition of “disabled.”
Only by having a copy of your disability plan will you know the plan’s exact wording and definition of “disability.” It is the policy’s definition of disability that determines whether benefits are payable in your specific instance.
Read the definition carefully, because with many long term disability plans the definition of disability may change after the first 24 months. A common example is that your plan might pay long term disability benefits for 24 months based on the fact that you are unable to perform your “own occupation.” After 24 months the plan’s definition of disability may change to where the plan only pays long term disability benefits based on whether you are unable to perform “any occupation” – a much different and more difficult set of criteria to be approved for. Many claimants are shocked to find their disability benefits terminated at 24 months because of the change in the definition of disability.
A good ERISA lawyer is prepared for this and many other nuances and pitfalls associated with disability claims which fall under ERISA rules. Your plan will specify various other obligations that you must be aware of.
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How do I get a copy of my employer’s disability plan?
You may send a written request to the insurance company. If the plan administrator is your employer, you will need to make a written request to your employer. Depending on the size of your company, the request may go through the Human Resources department or simply though an administrative office. Make it clear that the copy you are requesting is the complete long term disability plan, not a summary description of the policy.
Get help from an experienced ERISA attorney
It is imperative that you get the help you need to understand the legalese in your policy, and to properly appeal your claim and not fall victim to the insurance company’s denial tactics.
Our disability attorneys understand that ERISA disability claims are set up in favor of the insurance companies. We can help you with every single aspect of your appeal and guide your claim through the appeals process as well as litigating the claim in federal court.
To get clear on what your options are and what you need to do to prevail in obtaining the disability benefits you deserve, contact Marc Whitehead & Associates.
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