President Gerald Ford had been in office less than a month when he put his signature on the Employee Retirement Income Security Act of 1974 in a Labor Day White House ceremony. Since then, ERISA has been amended a number of times to strengthen its protections of American workers.
One of its most important features is its safeguarding of employees who request disability benefits from their workplace disability insurance plans. ERISA is clear: workers are to receive full reviews of their claims and must be given a fair chance to appeal denials of claims.
These requirements are to promote fairness and accuracy in the process, but also to protect workers with disabilities from financial ruin and emotional hardship caused by improper denial of disability insurance benefits.
Section 503 of ERISA requires disability benefits plans to notify plan participants of a claim denial, as well as to provide a full, fair review of the rejection. The Department of Labor added protections to those requirements, enabling claimants to respond to the evidence cited in the denial of his or her claim and the reasoning used in the denial.
How would a claimant be sure of the reasoning used to deny their claim? The Department of Labor requires benefits denial notices to explain that reasoning and the standards that were used in the decision.
Claimants and their employment law attorneys are also entitled to receive, upon request, the entire claim file and all relevant documents. A benefit denial notice is also to include any rules, standards and similar criteria used in rejecting a claim.
And if you and your attorney appeal a claims decision, plans cannot deny benefits based on new or additional information that wasn’t in their initial claims decision – unless the plan first gives the claimant and their attorney notice and a fair chance to respond.
There is no doubt that disability benefits claims are of enormous importance to you, your family and your future. A denied claim can have devastating, long-term effects on your physical and financial health.
An employment law attorney experienced in appealing denials of claims under insurance policies paid by employers can help you get the benefits you need and deserve.