Does ERISA protect one’s right to appeal a disability denial?

Professionals in well-compensated careers often receive a variety of benefits from their employers. In addition to paid leave and health insurance, they may also have long-term disability insurance coverage.

Federal disability benefits come nowhere close to replacing a worker’s lost wages when they earn a competitive salary. People who suddenly become unable to work due to medical emergencies could be at risk of losing their homes and facing other aggressive collection efforts.

Long-term disability insurance coverage can help people afford their basic cost-of-living expenses until they recover or become eligible for retirement benefits. Policies provided by employers are typically subject to the legal requirements of the Employee Retirement Income Security Act of 1974 (ERISA).

Do professionals with ERISA-governed disability benefits have the right to appeal under ERISA?

ERISA provides for a single appeal

ERISA protects those who rely on employer benefits during medical emergencies or after retirement. Professionals in need of long-term disability benefits because they cannot work have rights protected by ERISA that those making claims against private policies may not have.

For example, ERISA imposes a fiduciary duty on the insurance company. Those processing claims should act in the best interests of policyholders rather than prioritizing the company’s financial success. ERISA also protects the right to file an appeal after insurance professionals deny a long-term disability insurance claim.

The insurance company should provide the policyholder with an opportunity to correct issues with their paperwork and submit additional documentation. Navigating this process successfully often requires the support of a professional familiar with ERISA claims.

Ideally, an appeal leads to an applicant’s approval for benefits. Unfortunately, not all appeals are successful. Thankfully, ERISA also provides the option of filing a lawsuit against the insurance company following an unsuccessful appeal.

There are limitations on that litigation, including on the evidence used in court. Generally speaking, only documentation made available to the insurance company during the initial claim or appeal plays a role in the civil litigation process.

People already feeling overwhelmed by their medical challenges and financial stress typically cannot fully educate themselves about ERISA and long-term disability claims. They usually require assistance to make use of their rights.

Bringing policy documents and letters from the insurance company to a legal professional for review can help people explore their options. Those denied ERISA long-term disability coverage may be able to appeal successfully or may even be able to file a lawsuit.