Steps You Must Follow to File an ERISA Claim

Employer-sponsored long-term disability (LTD) plans are typically governed by a federal law known as ERISA (i.e., the Employee Retirement Income Security Act of 1974). To apply for benefits, you need to file a claim with your long-term disability insurance company. When applying, you will likely need to demonstrate that you have a disability that is covered under the applicable policy and that your disability leaves you unable to maintain gainful employment. 

Overview of ERISA Protections

ERISA provides several key protections for employees, including:

• ERISA makes the long-term disability insurance company a fiduciary, which means that it must act prudently in your interests when administering a claim.
• The insurance company must provide you with a full and fair review when deciding a claim. 
• The plan administrator must disclose relevant information, including the plan description and the specific reasons for a claim denial. 
• If an insurance company wrongfully denies your claim or terminates your benefits, you have the right to file a lawsuit in federal court.

Filing an ERISA Claim

There are multiple steps associated with filing an ERISA claim. Generally speaking, the first step is to review your long-term disability insurance policy. Analyze the policy for key terms such as what is considered a disability, the types of evidence you need to support your claim, and how long you must be disabled before you are eligible to file a claim (commonly referred to as the elimination period).

Step two is to gather all necessary evidence. To be approved for LTD benefits, you will need to prove that (1) you have a disability that is covered by your plan and (2) this disability prevents you from working (either in your own occupation or any occupation, depending on the terms of the policy). Examples of evidence that you might include to support your claim include medical records, results from any medical tests, medication lists, and a letter from your treating physician explaining your limitations based on your disability..

Step three is to file your ERISA claim with the plan administrator. Carefully check the plan document to make sure that you are following the correct procedures, such as including an employee statement and a statement from your employer.

Once your application is filed, you will need to be patient and wait for a formal decision. Under ERISA, the plan administrator has approximately 45 days to decide on the claim. However, if they have a valid reason that they cannot decide within this period of time, they can request 2 extensions of up to 30 days each.

Have Questions About ERISA? Speak to a Respected Disability Benefits Law Firm

Bross & Frankel assists individuals with all phases of ERISA claims, from filing a claim to appealing a claim denial at the administrative level to filing a federal lawsuit. If you are contemplating an LTD claim, our ERISA disability lawyers can help. Reach out to our law offices to schedule a free consultation today.