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What to do if Your Claim for Long-Term Disability Benefits was Denied

Posted in ERISA. Tuesday, May 16th, 2017

Most employers offer long-term disability insurance policies to their employees to protect them in the event of a serious illness or disability. However, even when an employer does not offer these types of benefits, a person can purchase a policy from a private insurer. Unfortunately, employers and private insurers often deny valid long-term disability claims in an effort to save money, which can have devastating consequences for policyholders who are unable to return to work.

However, those whose claims have been denied do have the option of appealing the denial, either through the Employee Retirement Income Security Act (ERISA) appeals process or the court system. Filing a claim or attempting to appeal a denial can be time-consuming and difficult, so if you were recently injured or diagnosed with a debilitating illness and are unable to work, it is critical to contact an experienced long-term disability attorney who can explain your legal options.

Employer-Provided Policies

Companies that choose to offer long-term disability benefits to their employees must comply with the terms contained in ERISA. For instance, when an employer denies a claim, the disabled employee must first go through a specific appeals process before he or she can file a lawsuit in court. Those who choose to appeal a denied claim must do so within 180 days of the initial denial and must submit additional information to the insurer, including:

  • Extensive medical records, including physician notes and emergency room records;
  • Written letters from the treating physician describing the claimant’s condition and limitations; and
  • Third party reports from friends and family outlining the claimant’s physical limitations.

If after reviewing a claim, the company affirms its decision to deny benefits, the claimant can file a lawsuit in federal court. Unfortunately, plaintiffs appealing a denied claim cannot seek punitive damages in court, as these types of claims are preempted by ERISA. For this reason, claimants are limited to suing for the benefits that they were owed under their plan.

Private Insurers

Government and church employers are not required by law to abide by the terms of ERISA. This means that a policyholder whose claim has been denied does not have to go through the specific ERISA-approved appeals process, although he or she may be required to exhaust the policy’s internal appeals process before filing a claim in court. After providing additional medical documentation and addressing any problems with the original claim application, policyholders can then file claims of breach of contract, bad faith, or negligence in state court. Because these types of claims do not fall under the purview of ERISA, claimants may seek punitive damages from the court.  

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

To learn more about how to file an appeal of a denied long-term disability claim, please contact the Law Office of Mike Gertner at 614-463-9393 or by sending us a brief message and we’ll help you schedule a free consultation with a dedicated long-term disability attorney.