As a resident of Texas who has a long-term disability insurance policy through your place of employment, chances are, the tenets of the Employee Retirement Income Security Act of 1974 apply to your policy. Therefore, if you file a claim and receive a denial in response to it, you may be able to find a more favorable solution by filing an ERISA appeal. Attorney Jon Michael Smith has considerable experience helping employees file ERISA claim appeals, and he has helped many people facing similar circumstances pursue solutions that meet their needs.
According to the U.S. Department of Labor, your insurer may initially deny your claim for any number of reasons. The company may, for example, deny your claim because it says you were not eligible for benefits in the first place. It may, too, do so because you failed to submit enough information or documentation about your condition, or because you utilized services not covered by your current plan.
Regardless of your insurer’s reason for denying your claim, there are certain steps you must take in order to move forward with an appeal. First, you will want to take a close look at your claim denial notice. If necessary, you can request additional information from your insurer that relates to it, which might include documents, records and the names of any medical professionals who had a say in deciding your fate.
Once you gather all the documentation you want to submit in your ERISA appeal, which will typically include any additional information you want your insurer to consider, you need to submit it to the person named in the denial notice. There are clearly defined timelines for doing so, and you will need to submit all necessary information and documentation within 180 days of the day you received your claim denial. You can find out more about this topic by exploring our webpage.