The culmination of a years-long push for stricter oversight regarding employer-sponsored benefit plans saw Congress pass the Employee Retirement Income Security Act (ERISA) in 1974. In the decades since then, the law has led to tight regulations and standards governing the administration of private-sector plans—including the management of long-term disability benefits.
Suppose you’re subject to an employer-sponsored plan within the private sector. In that case, you must understand the law’s influence over both the framework for submitting ERISA claims and the administration of that plan. Essentially, the law outlines the governing principles you’ll need to appeal to to fight an unjust denial of your long-term disability benefits.
Your ERISA plan administrator processes your long-term disability claim. However, this administrator is ultimately subject to the guidelines and regulations laid out by the law—making the ERISA the ultimate authority over your claim. So, let’s untangle the convoluted paper shield that is ERISA.
Unpacking Different Types of Plans Under ERISA
There are a wide range of plans that fall under this law. In fact, the majority of employer-sponsored benefits are subject to the regulatory guidelines outlined for ERISA plans.
To illustrate the scope of the law, the following common insurance benefits—when sponsored by a private employer—are all generally covered by ERISA:
- Short and long-term disability plans
- Long-term care
- Life insurance
- Retirement or pension plans
- Health benefits
A benefits plan doesn’t need to be funded entirely by an employer to qualify under ERISA law. Even if employees pay their own premiums, a plan still qualifies if your employer contributes via a discount or negotiated rate structure.
In specific relation to long-term disability benefits, ERISA plans provide income replacement to qualified claimants; it also sets strict reporting requirements for the disclosure of plan information. The law also creates a clear structure for the submission of ERISA claims and appeals and sets standards for employee benefits administration.
Your Rights Under ERISA
If your plan is covered under ERISA, you’re guaranteed a number of rights and benefits. The law asserts that the plan’s fiduciaries or administrators must act in the interest of the plan’s participants. Wronged parties may bring a case to federal court if the administrator has breached their duty.
Put simply, this guarantees you can bring your denied claim to court if you believe your benefits have been wrongly denied. Also, a federal judge can determine which party is responsible for any costs and fees during the court process.
ERISA also guarantees your right to be provided with plan information. On top of all these benefits, the law also makes the establishment of an appeals process a requirement.
Notably, your submission of a claim cannot legally result in a retaliation or change to your status as an employee.
Benefits Afforded by ERISA Plans for Long-Term Disability
ERISA is a comprehensive and exhaustive law that guides the administration of benefits in a variety of capacities. However, if you’re eligible for long-term disability benefits that have been denied to you, it’s important to know how the law specifically applies to your plan structure.
First and foremost, the ERISA requires administrators to consider their best interests when deciding. This means their decision must align with the plan’s terms and the presented evidence.
The law also affirms that you must have access to information regarding the details of all ERISA plans and how to begin internal appeals processes. If you receive a denial for your claim, you must submit your appeal within 180 days of receiving a denial letter. However, ERISA also requires you to exhaust the appeals process before filing a lawsuit.
It’s important to note that a lawsuit generally limits evidence to that submitted initially during the appeals process. This makes crafting an airtight appeal critical.
Navigating the Complex World of ERISA
The breadth of the regulations shaping ERISA plans—combined with the internal details of your particular plan—can make submitting a long-term disability claim exceedingly difficult. To start, it’s important to bring forward medical, employment, and any supporting documentation you have during your initial claim submission.
Should your claim be denied, the best thing you can do is reach out to a firm like Kantor & Kantor with experienced long-term disability lawyers. Appeals are often denied due to procedural errors, missing evidence, or a failure to make a convincing argument; an attorney can leverage their extensive knowledge and experience to create a robust and complete appeal. This is especially vital should your final appeal be denied, since the documents you’ve already submitted during internal processes will form the basis of the case in court.
Most ERISA long-term disability lawsuits don’t require testimony or the presentation of evidence. Instead, they are administratively reviewed through the filed documentation. So, if you’re working with an ERISA attorney, they will be able to craft a convincing case to represent your interests in court.
Finding Experienced Representation For ERISA Plans
Receiving a denial letter after submitting a long-term disability claim for your ERISA plan is frightening for anyone. After all, adjusting to the physical impacts of a disability is hard enough. You shouldn’t have to unjustly incur financial burdens instead of your rightly deserved benefits.
Unfortunately, far too many claims are denied—and without professional representation, many never receive the benefits they are owed. The complexity of the appeals process necessitates the help of a legal professional to navigate effectively.
However, you also can’t simply call the nearest legal firm. ERISA law is niche, and many attorneys don’t have the necessary experience to create a strong case. So, you’ll need to find an ERISA attorney who has the background to take on your case.
Kantor & Kantor has some of the most experienced ERISA lawyers available. Reach out to set up a consultation with an attorney who specializes in ERISA law today.
