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Reasons for ERISA claim denial in Texas

On Behalf of | Aug 18, 2022 | erisa claims | 0 comments

Under the Employee Retirement Income Security Act (ERISA), employers are required to ensure that employees receive the long-term disability (LTD) benefits they are entitled to receive. However, ERISA claim denials are more common than people realize. As you begin your application for disability benefits, keep these reasons for claim denial in mind.

Lack of medical evidence

A key part to recovering benefits is establishing that you have a disability that meets the necessary criteria. Many ERISA claims are denied because the claimant has not sufficiently proven their disability with evidence. Some common issues include:

  • Failure to undergo treatment on a regular basis (e.g., cancelling medical appointments)
  • Failure to provide complete medical records
  • Failure to provide statement from treating physician regarding the severity of your condition and prognosis
  • Failure to adhere to doctor’s recommendations

Pre-existing conditions

Many ERISA claims are denied due to an exclusion in the disability policy. Many disability policies include an exclusion for pre-existing conditions. For example, if a claimant was treated for a condition sometime during the year before the insurance coverage began, even if it was unrelated to their current disability, the claims administrator may deny their claim under the pre-existing condition exclusion.

Errors in application process

Many denials are the result of run-of-the-mill mistakes during the application process. Some of these mistakes may include:

  • Failure to include accurate information
  • Failure to meet deadlines
  • Failure to include necessary details

A Texas attorney specializing in ERISA claims can help you avoid these common reasons for denial. In the event your claim is denied, your attorney can help you file an appeal to overturn your denial.