Group Disability Policies/ERISA

April 20,2010
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If you participate in a Long Term Disability (LTD) plan offered by your employer, even if you pay some or all of the premiums you are considered to be part of a group plan. Group disability plans are often referred to as ERISA claims because the procedures governing them are found in the Employee Retirement Income Security Act (ERISA).

Employees of most private companies that provide retirement and other benefits—including LTD benefits—have certain protective rights under the Employee Retirement Income Security Act of 1974 (ERISA). ERISA also outlines how appeals are handled and lawsuits are filed in these cases. In addition, the United States Department of Labor also publishes regulations that must be followed in group policy disability claims.

Although you as a policyholder have certain rights in the claims process, you must follow specific procedures and time limits in order to make a successful claim under ERISA for Long Term Disability benefits. Similarly strict guidelines apply if you are appealing a claim that has been denied or suspended. These guidelines and regulations can be confusing, and if they are not followed carefully your entire case could be compromised.

The earlier you hire an attorney, the better the odds that you will win your claim and maximize your benefits. At Hermann Law Group, we feel it is in your best interests to have us involved even before you apply for benefits, so that we can prevent you from making any mistakes when your claim is filed.

If you do not hire an attorney to help you file your initial claim, you should do so immediately after you are first denied benefits. The insurance company or claims administrator may consider a simple inquiry or a submission of additional records to be your appeal, even when you don’t mean it to be. If you are represented by an attorney, he or she should help you to collect the additional information you need, and will file your appeal only when it is fully prepared. If you wait to hire an attorney until after the final determination by your insurance company (often called the “Administrative appeal”), your only course of action is to file a lawsuit against them—but at this point, no additional evidence can be added to your file. So long as you are represented before the final determination, additional critical material can still be added to your claim and considered later in Federal Court.

Hermann Law Group has over 40 years of experience and has successfully represented thousands of clients seeking disability. We know how to increase your chances of winning before the insurance company decides your case.