While no one wants to see you suffer due to injury or ilness, not everyone wants to pay you for it. If you have coverage through your employer that falls under ERISA guidelines, you need to take particular care as the rules are complex.
Understanding who is on your side and who is either against you or incapable of providing adequate support will be crucial if you file an ERISA disability claim. Let’s look at three categories of people to see whether they are friends or foes.
The insurance company
Insurers tell you they will be there when you need them, but the truth is, they will try their best not to be. This is not because they are evil or malicious. Rather, it is in the nature of their business. They exist, first and foremost, to make profit. Think about their business model — they collect money from many people and pay out to a few people. The more people they have to pay out to, or the more they have to pay out, the more their balance sheet tips in the wrong direction.
You would hope your employer is rooting for you. After all, if your claim turns into a battle, other employees may wonder why the employer offered this particular policy. Yet regardless of the allegiances of your boss or other staff, they probably know very little about the subject. ERISA is a complex area of law, so relying on someone whose training and insight lies elsewhere may harm your chance of getting the result you need.
Anyone the insurer recommends
If the insurer recommends you see a named specialist, think twice. Every insurer has a list of preferred people to work with. It is not in the insurers’ interest to have people who frequently favor the claimant on that list. It is in their interest to work with people who help them reduce or deny payouts.
Filing an ERISA claim and compiling everything you need to support that claim is complex, so support from someone that will help you understand your rights and fight for them will be crucial.