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Long Term Disability Attorney By Me

Employer-provided long-term disability insurance is governed by the Employee Retirement Income Security Act (ERISA), which requires both employers and employees to comply with specific procedures and time limits when filing claims for benefits. Filing a claim while adhering to all of these requirements can be difficult, so if you were recently injured in an accident or diagnosed with a debilitating condition, it is crucial to retain an experienced long-term disability attorney who can ensure that you file your claim by the appropriate deadline.

Filing a Claim

Before filing a claim, it is important for a claimant to review the summary plan description (SPD), which each policyholder should receive from their employer. SPDs provide a detailed overview of the coverage provided by the plan, including:

  • The benefits it provides;
  • How to file a claim for benefits;
  • How to file an appeal; and
  • The claimant’s rights and responsibilities under ERISA.

The SPD will also outline the plan’s definition of disability and give claimants an idea of the evidence that they will be required to submit in order to prove disability. It is important to check the SPD before filing a claim as each company’s claims procedures may be subtly different. For instance, the SPD will tell claimants:

  • Where they should file their claim;
  • What information is required to file a claim; and
  • Whom to contact regarding any questions about the plan.

Once a claim has been submitted, the insurer must provide an answer to the claimant within 45 days of receipt. Although the plan’s administrator can extend this deadline by up to 30 days, he or she must do so before the end of the 45 day period and explain the reason for the delay. If further information must be submitted, the claimant has an additional 45 days from the date of the request to provide it. The claim must then be decided at least 30 days after the additional information was supplied. Private insurers who are not required to comply with the terms of ERISA may have alternative deadlines, so it is critical to check with your plan’s administrator before filing a claim.

Denials

Coverage is denied to qualifying policyholders on a regular basis. Some of the most common reasons include:

  • A lack of supportive medical documents;
  • A failure to receive regular medical treatment;
  • An insufficient doctor’s statement describing the nature of the diagnosis, recommended treatments, and the claimant’s physical or mental limitations;
  • Failing to meet the definition of disabled;
  • The existence of evidence contradicting statements made by the claimant; and
  • Missed deadlines.

Fortunately, policyholders who have had their claims denied can appeal the decision. Policies that fall under the purview of ERISA require claimants to go through a series of administrative appeals before they can file a claim in court, while policyholders whose coverage is provided by a private insurer can file a claim in state court almost immediately.

Contact us Today to Speak With an Experienced Long-Term Disability Attorney

If you are an Ohio resident and are unable to work as a result of a disability or medical condition, please contact us at the Law Office of Mike Gertner by calling 614-463-9393 today.