Among other things, the Employee Retirement Income Security Act (ERISA) governs plans that cover workers in case they become disabled prior to retiring. For Wisconsin workers, this can be something of a security blanket to keep them from financial turmoil and fear about the future if they become injured.
Still, when they seek long-term disability benefits through an ERISA-covered plan, many people are concerned about what the future holds.
It’s disappointing to have a disability claim denied, but it does not automatically mean the case is over. There are strategies to appeal the denied claim and it could be effective in having the decision reversed and being awarded the benefits the person so desperately needs.
Know the key facts about a denied ERISA claim
After making the claim and receiving the denial, the plan administrator must, according to the law, have certain elements in the notice. The claimant must be informed why the claim was denied. Often, there was a problem with the medical source the claimant used and this was the impetus for the claim being denied.
In the plan, there are specific provisions that the claimant must meet to get approved. If they do not, then the claim will be denied. Fortunately, there are avenues to appeal the denial. These can be effective, so people should not function under the assumption that the denial means the case is over and an appeal is merely cosmetic.
Among the reasons why a person’s claim was denied include a lack of eligibility; a clerical misstep; or problems with the medical or vocational evidence. For simple issues such as a lack of information, the claimant can provide what was missing to rectify the situation. There are time limits to file the appeal and it must be done within 180 days of receiving the denial.
The claimant has the right to expect the appeal to take place within a “reasonable” amount of time. It cannot go beyond 45 days after the request for appeal. Some cases warrant an extension and the plan could have another 45 days to make its decision. Exceptions to the time-limit rules are if there is a collectively bargained agreement regarding the plan from a single employer or a multi-employer agreement.
If the appeal does not result in an approval, the case is not necessarily over. The claimant has legal options to pursue such as going to court. When the plan does not adhere to the rules regarding claims, then the claimant can immediately file a court claim. The expectation is that the decision will be made without prejudice, so people can look at the individual circumstances to gauge whether they were not treated fairly.
Long-term disability claim denials can be appealed
People who are seeking long-term disability benefits through ERISA must be aware that they have rights and can pursue various strategies after a denial. The entire case can be scrutinized as well as the decision that led to the denial. These cases can be complicated and it is imperative to understand the process from start to end to try and reach a fair outcome and receive the benefits to help them with their medical challenges. The experienced attorneys at Alan C. Olson & Associates can help.
