Injured employees are initially encouraged when they learn that they have long-term disability coverage through their jobs that is governed by federal law. However, the difficulties of the situation become apparent when they learn that the process generally favors the insurance companies that provide the coverage. This means that getting the benefits that you need is not always easy. When you realize that you are unable to work, you will need to go through the insurance company. ERISA gives very strict deadlines and requirements for the process, and these often make life more difficult for you as a claimant. Oftentimes, that emboldens the insurance company to deny your initial claim. Unlike a regular insurance policy, you cannot sue a company for a bad faith denial under ERISA. This means that you could end up having to fight for your benefits after the insurance company has denied your claim. You want the help of Malvern long term disability attorneys.
How You Qualify for Long-Term Disability Benefits
You qualify for long-term disability benefits when you have a debilitating disease that keeps you from working. This could include conditions such as:
- Arthritis
- Bipolar disorder
- Depression
- Multiple sclerosis
When you first submit your claim for long-term disability, you must present documentation of your medical condition that shows why you cannot work. It is important that your claim is thorough and spells the condition out in detail for the insurance company. They may deny your claim with the slightest of excuses. All they have to do is tell why they turned down your claim.
Appealing an ERISA Long-Term Benefits Claim Denial
You have the right to file an administrative appeal of a coverage denial, and you must take this process seriously. Your first step of appeal is with the insurance company itself. They are the ones who will decide your appeal. While you may be suspicious of appealing your denial to the company that turned down your claim in the first place, you have to fully participate in this process. The insurance company will consider your arguments and will issue a decision on your appeal. If they continue to maintain that you cannot receive benefits, you have the ability to file a lawsuit for benefits. This lawsuit does not allow you to introduce new evidence. Instead, the court can only consider the evidence that was introduced. This is why you must present the best possible case to the insurance company first since that will be the record for your lawsuit. The stakes are high for your ERISA long-term disability claim since it is your only way to receive benefits when you cannot work because of a health condition that is not a work-related injury. However, it is not always an easy process, so you must take it seriously from the outset.
Experienced Malvern Long-Term Disability Lawyers
The attorneys at The Garner Firm, Ltd. are experienced at helping clients through all parts of the long-term disability process. Contact us today to learn how we could help you file your claim or appeal a denial of your application for benefits.