The Employee Retirement Income Security Act (ERISA) is an important safeguard for the rights of employees and is the federal law under which most employee benefits are provided by employers. ERISA requires that plan beneficiaries be fully informed of their rights and the status of health and retirement plans and other benefit plans, like long-term disability or short-term disability.
I focus on ERISA disability benefit claims.
ERISA provides important protections for employees by allowing them to pursue legal action when their rights to disability benefits are denied. If your long-term disability or short-term disability claim has been denied, you may have grounds to pursue an ERISA claim in Louisiana.
The Erisa Disability Claim Process
If you are sick or injured and cannot work, you may file a claim for short-term or long-term disability benefits. The process seems easy enough, but it is filled with pitfalls and landmines that can destroy your claim.
You will generally get the initial application from your human resources office.
After you make your application, the disability benefit insurer will contact you. Usually, it will be a “very nice” and “friendly” case manager or claims manager. This person will put you at ease (by design) and be your “guidance” through the process.
Do not be fooled. This is not your friend. This is an employee of an insurance company who does not want to pay you benefits. They want to get information that can defeat or minimize your claim.
You will have to provide all your doctor’s and medical facilities. The company will obtain your records and will often speak to your doctor. The insurance company then makes a decision on your initial claim. The ERISA disability insurer has a certain amount of time to make their decision under ERISA.
If your initial decision is favorable – that is you get benefits – great. But, the claim is not over. The ERISA LTD claim manager will review your claim periodically (usually every 6 or 12 months). The policy requires you to cooperate and provide the requested information. If you take longer than they want, your claim may be denied.
Your claim will also be reviewed after a period of time (usually 24 months) under what the industry calls the “ANY OCCUPATION” review. Your claim may be denied here as well. You have to appeal to the long-term disability insurer in order to file a court case.
At every step along the way, the long-term disability insurer must make decisions within certain time frames. If they miss the deadlines, there may be damages available to you. But, you must also perform certain actions within certain time frames. If you miss your deadline, in some cases the penalty is the loss of your claim.
TALK TO AN ERISA CLAIMS ATTORNEY IN LOUISIANA
If you have been denied ERISA long-term disability or short-term disability benefits, I can help. Contact my team by calling 985-240-9773 today to learn more about the legal options that are available to you and what we can do to help you fight your denial.