What are your options when employee benefits are denied?

On Behalf of | Oct 11, 2021 | Erisa & Employee Benefits |

After a severe injury or illness, the long-term disability (LTD) benefits your employer provides you with can be the essential benefit you need to get by. While the benefit may be specifically for this kind of situation, earning the benefit may not be as easy as you expect it to be. After your application for these benefits ends with a denial, what can you do to protect yourself?

LTD benefits are only available to 35% of employees, so if you have these benefits available, it is important to do everything in your power to use them when you need them.

What You Can Do

The Employee Retirement Income Security Act of 1974 (ERISA) is a law that dictates the minimum standards of employer-provided retirement and health plans throughout private businesses. Part of ERISA’s specifications requires insurers to offer an appeals process in their coverage plans. Because of this, if your application for benefits ends in denial, you can appeal the decision to try to earn the benefits again.

ERISA requires that employees have at least 180 days to file their first appeal. The resulting decision can only come from the contents of the appeal and not the initial application. This can be beneficial for an employee because if their condition has gotten worse, it strengthens their claim for benefits in their appeal.

If the insurance company denies the appeal, you may still have options to gain benefits. Some insurance policies allow for a second appeal, although the window to file this appeal may be smaller than the original 180 days.

How you can improve your odds

Whether you are starting your first appeal or you are trying to confirm if you can submit a second appeal, let the guidance of an experienced attorney help you. A skilled lawyer can help you make your strongest appeal the first time around, so you do not leave anything to chance with your benefits. If you are trying to secure LTD benefits, consult with an attorney about what you can do to protect your best interests.