How do you appeal a denied ERISA claim?

There are several different types of long-term disability insurance, and the details of your policy may have a significant impact on the appeals process if your claim gets denied. If you get your LTD insurance through your employer, chances are that your claim falls under the ERISA (Employee Retirement Income Security Act of 1974) law.

Once you file an ERISA claim, you must wait to see if your insurer accepts it. If the insurer denies your disability claim, you generally have 180 days to submit a request for review, however the appeal deadline can be as short as 60 days for life and health claims.

Understanding the denial

According to FindLaw, the ERISA regulations that govern employer-provided LTD insurance plans are extremely complex, so the claim and appeals process may be very challenging. However, your insurer must provide you with a detailed explanation of the reasons behind your ERISA claim denial. The insurance provider must also give you instructions for filing an appeal.

Filing an appeal

If you choose to file an appeal of a denied ERISA disability claim, the first step is an internal appeal with your insurance provider. If that does not work, you may file a lawsuit, and a court will review your information and the details of the ERISA insurance plan. After this review, the court will decide whether your insurer legally denied your claim.

Part of preparing for your appeal involves gathering evidence of your disability. Having this documentation may encourage a court to accept your appeal, and it may also help ensure you get the correct LTD benefits you deserve based on your policy. Some documents that may be important for your appeal include a copy of your original claim, diagnosis information from your physician, statements about your disability from coworkers or other witnesses and documentation of your LTD insurance policy.