The ERISA plan can be referred to as several different things, such as “the policy,” “the long-term disability policy,” or “the LTD policy,” refers to a specific document that is held by the employer and/or plan administrator. It is an official document that covers everything from who in your company is covered for the benefit, to how much you can expect to receive and for how long, to the specific definitions of disability and other important terminology, to how to appeal, and other very important information. The plan or policy is the governing document that directs how the insurance company and/or your employer is to handle your claim for disability benefits.

ERISA was put in place with the intention of protecting the interests of employees and their families with regard to their pensions, disability insurance plans, healthcare, and other group benefit packages. While it does set forth certain rights of employees, such as access to certain documentation held by the insurance company or decision maker, it also severely restricts an employee’s ability to pursue certain actions against the insurance company for improper denials of short-term and long-term disability claims.

ERISA covers benefit plans provided by nearly every employer in the private sector. Certain benefit plans are excluded from ERISA, including benefits issued by government employers, benefits issued by churches or other religious organizations, and insurance policies that you purchase on your own. There are other exemptions from ERISA, but these are a few of the most common.

If your application for long-term disability benefits is denied, the insurer is required to provide you at least one appeal, and it may require up to two appeals. Most long-term disability policies permit, but do not require, you to file a second appeal. Therefore, the insurance company potentially could deny your application, deny your first appeal, and deny your second appeal as well, for a total of three denials.

A skilled and experienced ERISA disability lawyer will speak with the disabled worker personally to make sure he or she fully understands disability policy, the procedures moving forward, and the impact that all medical conditions have on the insured’s ability to perform his or her (or any) job. The lawyer will then put together a thorough plan to gather all of the evidence needed to support the application or appeal for disability benefits, including reviewing any denial or termination letters, reviewing the insurance company’s claim file, coordinating with your doctors, and obtaining and submitting all forms, statements, and medical records to prove your qualification for a disability benefit. A disability lawyer should have experience with appealing denials and litigating these cases in court so that the claim is presented properly from the start.

A skilled and experienced ERISA disability lawyer will speak with the disabled worker personally to make sure he or she fully understands disability policy, the procedures moving forward, and the impact that all medical conditions have on the insured’s ability to perform his or her (or any) job. The lawyer will then put together a thorough plan to gather all of the evidence needed to support the application or appeal for disability benefits, including reviewing any denial or termination letters, reviewing the insurance company’s claim file, coordinating with your doctors, and obtaining and submitting all forms, statements, and medical records to prove your qualification for a disability benefit. A disability lawyer should have experience with appealing denials and litigating these cases in court so that the claim is presented properly from the start.

ERISA law states that an insurance company has 45 days after you submit your application to issue its decision on your claim for disability benefits. However, the insurance company is permitted to take up to two 30-day extensions if it cannot make the decision within the initial 45-day period. 

If you are denied, an appeal must be filed within 180 days of the denial, and the insurance company has 45 days to issue its decision after the appeal is received. The insurance company is permitted an additional 45-day extension if special circumstances exist that would require extra time to make its decision. If you are again denied and submit a second appeal (if allowed or required), the same timeframe applies to the second appeal. 

If you have to file a lawsuit, it will likely take several months to over a year for your case to reach a final decision by the judge.