Disability payments are essential for employees to maintain their standard of living after they are unable to work due to a workplace injury. Unfortunately, not all employer insurance companies in Texas wish to pay what is owed to the employee. When the company denies a claim, the next step is to file a claim under the Employee Retirement Income Act of 1974. There are several steps employees should take in this process to receive the payments owed them.
ERISA does not cover expats living overseas. According to the U.S. Department of Labor, the ERISA is specifically for voluntary health and retirement plans within the private industry. Those plans complying with federally mandated laws such as workers’ compensation have no protection under the act.
Cornell Law School states that “the plan administrator shall notify the claimant…within a reasonable time” after a denial. The denial of the claim only has to be partial for the claimant to receive notification. The plan administrator is responsible for claimant notifications and any extensions deemed necessary. Claimants should receive either electronic or written notification on denials and reviews.
Upon denial of the insurance claim, the claimant can then appeal to the ERISA after administrative appeal. The act provides some benefits to claimants in the event of a denied claim. Unfortunately, the process of claim filing with the insurance company can take up to nine months with no payments received for the claimant. After which, the claimant can file a claim with ERISA. A federal judge is the ultimate decider in the case which can last two years.