If your plan administrator denies a benefits claim for your employer-sponsored benefits plan, a long term disability attorney may be able to help you to seek recovery through negotiations or a filed lawsuit. Employee benefits plans are covered under the Employee Retirement Income Security Act, or ERISA, which directs employers and plan administrators about how claims are supposed to be handled. Here is what you need to understand about ERISA and your claim.
What ERISA Covers
Plans that are already regulated and administered under state law are not covered by ERISA. This would include such things as unemployment or workers’ compensation. ERISA-covered plans include such things as pension plans, disability insurance, severance plans, health insurance, training programs, employer-sponsored daycare and scholarship programs, death benefits plans and those offering prepaid legal services. While there is nothing requiring an employer to offer any of these types of plans, if the employer does so anyway, they must do so in a way that follows all of the requirements outlined under ERISA.
ERISA Requirements
ERISA mandates that employers and companies that manage employee-benefits plans must operate them efficiently and in a financially sound way. The funds in the plan must be managed for the participating employees’ exclusive benefit. The investment and other decisions must be made without engaging in actions that pose a conflict of interest. Certain types of plan information must be disclosed to participating employees and to the government. Employers and plan administrators also must follow regulations that govern where plan funds can be invested. All participating employees must also be notified about how they can go about filing benefits claims and what the qualifications and criteria are for accessing benefits through the plan. Substantial changes to the terms of a plan may not be made without first notifying the employees. Employees must be informed about when they will vest under the plan and other assorted matters.
Your ERISA Claim
Claims for benefits from a plan governed by ERISA may not be wrongfully denied. Once you submit your initial claim, the administrator of the plan must accept or deny the claim within 90 days. If you receive a denial, ERISA tells administrators that they must include instructions with the denial that inform you how to request a review of the denial. You will have 60 days to submit your review request under the law. If it is again denied, you may then get the help of a long term disability attorney to file a lawsuit to try to seek the benefits you deserve.
Contact a Long Term Disability Attorney
If you have received a wrongful denial, it is important to get help. To speak with long term disability attorney David M. Hicks, call (314) 812-4885.
