Employees in New Jersey who are covered by employer-sponsored disability insurance plans must exercise their rights within the deadlines outlined in the Employee Retirement Income Security Act of 1974 (ERISA). This act establishes your rights to access benefits and appeal an insurer’s denial of your disability claim. Despite giving you rights, ERISA imposes strict deadlines. You must work within the timetable or risk losing the ability to appeal a denial.
What your employer must tell you
The law obligates your employer that is sponsoring the disability insurance to keep you informed of the plan’s benefits and procedures. You must receive documentation that explains:
- What the plan covers and does not cover
- How to file a claim upon becoming disabled
- Process for appealing a denied claim
ERISA claim deadlines
According to ERISA, the disability insurer has 45 days to respond to your claim for benefits. If the insurer notifies you that more time is needed to evaluate your records, then the law grants the insurer another 30 days. A claim that has gone longer than these regulatory deadlines without a response is a reason to learn about ERISA rights and consider your next steps.
How to appeal an ERISA disability denial
A denial letter must explain the reasoning behind the refusal to pay benefits. Your first step is to appeal the denial with the insurer. If rejection remains the outcome, you may advance the issue with a lawsuit that a judge will decide during a hearing.
Questions of disability can be complex, and people may receive unfair denials of benefits. To hopefully avoid a denial, your claim paperwork should include as much clinical documentation as possible about your disability. This is necessary because a judge can only decide your appeal based on the records sent to the insurer.