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ERISA, disability and appealing denied claims

On Behalf of | Aug 17, 2021 | Uncategorized

Individuals in Florida should know what to do if their work-sponsored disability claims are denied. Their rights in such a situation are governed by ERISA, or the Employee Retirement Income Security Act of 1974. That act sets standards for the benefits plans that companies offer to their employees. People need to understand what their options are if they don’t receive a response from their plan or get denied.

What ERISA covers

As it pertains to disability insurance, ERISA does not apply to government-sponsored plans. If you buy a long-term disability insurance plan as an individual, ERISA will not apply to that either. This law only applies to group insurance plans. ERISA does, however, cover both short- and long-term disability plans that are sponsored by private employers.

Defining “disability”

Your plan will have its own definition of what constitutes a disability. Some plans will define it as the inability to do your job. Some will define it as the inability to do any job. You can appeal a denial if your plan initially determines that you don’t meet its definition of disabled.

The appeals process

If your claim is denied, the plan must give you a reason why. It needs to provide this in writing whether that’s via letter or email. The denial notice must let you know if any information is missing and what that is. It must also provide instructions for how to appeal. For your part, you need to submit a request for review in writing.

If your appeal is denied or if you never receive a decision either way, there may still be hope. You can contact your EBSA, or Employee Benefits Security Administration, office for assistance. The EBSA is a government agency responsible for enforcing provisions of ERISA.