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Why ERISA claim denial may occur

On Behalf of | Oct 1, 2021 | ERISA

Since the Employee Retirement Security Act of 1974, ERISA has been setting the minimum standards for health and retirement plans to protect those who are on these plans. Unfortunately, ERISA claims are wrongfully denied on a regular basis. If you’re a New Jersey resident and your claim has been denied, you may want to file an appeal.

Common reasons for denial

Often, getting ERISA disability claims accepted is a delicate process. There are many reasons why claims are denied. A few key factors include:

  • Lack of medical evidence
  • Incorrectly filled-out forms
  • Missed deadlines

The list goes on ad nauseam because of the highly detailed requirements for filing an ERISA disability claim. To compound the problem, insurers in the past haven’t been required to be very specific in their reasons for denial, leaving the person filing to guess what went wrong.

A system that favors the insurance companies

The major issues with claim denial are baked into the very system itself: Rules that have long been in place are much more favorable to the insurer than they are to the insured. Under ERISA, the right to sue insurance companies is very limited. You are not entitled to a jury trial and many other rights and remedies which other, non-ERISA civil litigants are entitled.

New rules require more clarity from insurers

In an effort to prevent unjustly denied disability claims, the U.S. Department of Labor implemented new regulations to keep insurance companies accountable. This includes a required explanation that articulates why a claim didn’t go through rather than the company simply being able to arbitrarily shoot claims down.

Even with these new measures in place, the issue of claim denial still persists. Individuals who face denied ERISA claims may find that the only way to receive their benefits is to file an appeal.

While there are myriad reasons why an ERISA claim can be denied, it is possible to successfully appeal the denial. Like the initial application process, it involves completing paperwork accurately and submitting it within a certain deadline.