FAQ: 5 Reasons Why Your ERISA Disability Claim Benefits Were Denied

When you have an injury bad enough to keep you from working for a long time, the last thing you want to think about is your income. ERISA protects health benefits of over half of American workers according to Department of Labor reports and ERISA protects them along with other employee benefits.

ERISA was set up to protect retirement savings, ensuring that those looking after such savings are appropriately professional and held to a high standard. It is intended to ensure that the people in charge of savings act in the best interests of the saver, providing transparency and accountability.

You should concentrate on the things you need to get better. Unfortunately, it is not easy to worry about keeping your bills paid when you are afraid you won’t have a job when the injury heals.

The Employee Retirement Income Security Act (ERISA) was created in 1974 to ensure employers manage their workers’ retirement funds so that they are available when needed.

Whether or not your injury was on the job, your long-term disability insurance describes what you are entitled to under the law. However, many insurance companies and employers will take any opportunity to deny claims and prevent paying.

If you’re considering getting insured by Aflac, you must know why AFLAC would deny a claim before you sign on the dotted line.

So why would ERISA claims be denied? And what can you do about it?

What Reasons Are Used To Deny ERISA Claims?

Disability claims filed under ERISA get denied frequently. They can be turned down for several reasons, but it usually has to do with something completely avoidable. Attention to detail and proper advice are the most valuable tools when investigating a claim denial.

Regardless of the company’s size, they created a contract with you and should honor it.

The U.S. Department of Labor has published a detailed set of regulations addressing ERISA claims and appeals, which will often require legal assistance. 

How you handle the case can make it more difficult for a claim to be denied and avoiding mistakes will make it easier for you to get your benefit claim approved.

Medical Documentation

When you go to the doctor for your illness or injury, get a comprehensive statement detailing your diagnosis and why it is a disability. Document the reasons your disability will affect how you can perform your job duties.

The doctor should also be able to explain how your disability causes you to be unable to do things you once could and how it affects your overall quality of life.

Missing Paperwork

One of the biggest mistakes people make when filing ERISA claims is forgetting to fill out a particular form or leaving it out of their file. That is one of the easiest ways for an insurance company to deny coverage.

You should also pay close attention to all the deadlines as that is another way for them to avoid your claim.

Pre-Existing Conditions

Before filing a claim, you should be sure that your illness or injury was not due to a pre-existing condition.

Anything you received treatment for in the months before your coverage started that could have contributed to your condition can be used against you. If you believe your prior history has no bearing on your claim, you should discuss it with your lawyer before filing.

Evidence Contradicting Your Claim

Your lawyer will recommend that you stay away from social media and not post anything about your ERISA claim online.

You should avoid attempting activities that could question the severity of your disability. Insurance companies hire investigators to look into people making claims in an attempt to discredit them and scrupulous attention to your activity is important to ensure that any claim is not prejudiced.

Not Consulting an Attorney

The most common mistake people make when filing an ERISA disability claim is thinking they can do it independently.

Unsurprisingly, those claims get denied much more often. One of the reasons that can create difficulty for those who do not seek appropriate legal help with their ERISA claims is when an appeal is unsuccessful for any reason, which may result in a court not considering new evidence that may help win a successful claim. An experienced attorney’s involvement can help the appeal process with knowledge of what evidence is required to succeed and the manner in which it should be presented.

Final Thoughts

If you are preparing to file an ERISA disability claim make sure the evidence and time limits are properly adhered to. Time limits are another key element that requires careful attention.

A lawsuit can be filed should a claim be rejected and this may be held in a federal court, but the hearings are different from typical litigation cases where jury trials are not available and there is also a limit on what can be ‘discovered’, unlike most civil trials.

Legal assistance is key to success, so long as your attorney as ERISA experience, as this is one area of the law that involves appeals and all the other elements of civil claims, but has marked differences in how they are advanced, particularly when a claim is rejected. 

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