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Why ERISA long-term disability claims are confusing

On Behalf of | Oct 4, 2021 | ERISA

Are you confused about the laws governing the filing of disability claims under ERISA? Has your claim been denied, and you’re wondering why? If so, you’re not alone. Many New Jersey residents seeking disability payments are often denied the first time around because of incomplete filing or missing information. Here’s what you need to know.

ERISA has a different set of rules

ERISA is a federal program with a unique set of rules and deadlines that are quite different from those that plaintiffs encounter with private benefits. Your ERISA claim first goes to your company’s insurer or its claims adjusting company. When a claim is denied, the review must go through a pre-lawsuit administrative appeal to a different department in the insurance plan. Only when that appeal is denied can plaintiffs proceed to file lawsuits.

What you’ll face in the appeals process

Instead of a jury trial, ERISA claims to undergo a bench trial in federal court with a judge ruling on the appeal. You won’t be able to claim funds for emotional distress and punitive damages, but most likely, you’ll be able to recoup attorneys’ fees. ERISA also requires the insurance plan to provide a reasonable claims procedure, which involves a written claim and time-consuming requirements for medical records and supporting documents. ERISA disability plans often fail to give the plaintiffs timely information on the claims, yet the law provides you with steps you must follow if the company does not follow the proper procedures.

Other steps to take

In addition to pursuing long-term disability benefits under an ERISA plan, plaintiffs should also file for state or federal disability benefits, including those provided by Social Security. Often, ERISA appeals turn into approval once other types of disability claims have also been approved.

The process for all types of long-term disability claims can become frustrating. You’ll have time limits to follow, as well as a lot of paperwork to obtain and file. The bottom line is don’t take no for an answer and don’t go it alone.