September 2019 will mark 45 years since the signing of one of the more important laws affecting American employees, the Employee Retirement Income Security Act (ERISA). The 1974 law regulates certain benefits private employers can offer their employees.
ERISA governs employer-sponsored disability benefits
Many Americans may never realize how important ERISA is for protecting employee rights. But some quickly learn just how complex and difficult it can be to follow ERISA regulations once they file a disability income claim, and that claim is denied. Knowing a little about the claims process under ERISA might help you decide how to prepare yourself if the time comes.
How the disability claim process works under ERISA
First, from your employee handbook you may know ERISA requires employers to provide a few facts about your employer-sponsored disability plan, what’s covered and what isn’t, how to file a claim and how the appeals process goes if your claim is denied. At every step of the disability claim process, ERISA sets detailed, strict deadlines and guidelines for you and the insurance provider. You may find the many requirements difficult to follow and, at some points, to even understand.
In a nutshell, when you file a claim the provider can accept or deny it with a written explanation. You can appeal a denial and the insurer may accept or deny that appeal.
If the provider still denies your claim, you might appeal to a judge and argue that the insurer’s denial was improper according to the law. ERISA tightly limits what the judge can consider (only the written claim file) and what criterion to apply (only "abuse of discretion" by the company).
Small missteps by either side in deadlines and documentation can swing the decision.
How an attorney can help in the process
The insurer’s attorneys often have the advantage of both time and expertise. If you’re considering filing a disability claim through your employer-provided plan, you should think carefully about consulting a qualified attorney experienced in ERISA cases.