ERISA, otherwise known as the Employee Retirement Income Security Act, protects your disability benefits by setting standards for your employer’s benefits plan. If your disability claim gets unjustly denied, it may be necessary to file a federal lawsuit under ERISA. However, ERISA mandates a specific, step-by-step filing and appeals process that you need to follow before going to court. It may be necessary to seek legal counsel to understand what the federal government requires from both you and your employer in the ERISA disability claim process.
Every private-sector employer must provide a Summary Plan Description (SPD) detailing the disability benefits they offer and how you should apply. Generally, when you file an ERISA disability claim, your employer’s plan administrator must decide on it within 45 days.
Filing an Appeal
If they deny your claim, your employer’s plan administrator must send you a notice explaining why. At this point, you have 180 days to appeal the decision. The appeal cannot involve the same person who made the initial denial and needs a ruling in a similar time frame to your initial claim. In some cases, extensions may be necessary. If your appeal gets denied again, your last remaining recourse may be to file a federal lawsuit.
The explanation provided by your employer’s plan administrator, detailing their disagreement with your treating medical specialist, will give you and your lawyer a starting point for building a case. Unfortunately, it is not uncommon for employers to deny disability benefits despite the protection afforded to their employees under ERISA. If you believe you qualify for disability benefits, don’t hesitate to contact an experienced New Jersey disability lawyer to help you with the filing process and, if necessary, a lawsuit.