Long Term Disability Denial | What is Erisa
You are probably either very upset that you’ve been denied your insurance right now, or searching online to be sure you do not run up against a denial. Either way we hope this article helps you understand what you’re up against and gives you some ways to get through this complex system.
ERISA, Employee Retirement Income Security Act, which was original enacted in the 1970s was meant to preserve your retirement income. The Act has been amended many times since then and now under most cases requires the insurance company who may or may not pay you, the power to deny your benefits, rather than an impartial jury of your peers, or a court appointed judge.
According to the Department of Labor’s website:
Federal retirement law requires all plans to have a reasonable written procedure for processing your benefits claim and appeal if your claim is denied. The Summary Plan Description (SPD) should include your plan’s claims procedures. Usually, you fill out the required paperwork and submit it to the plan administrator, who then can tell you what your benefits will be and when they will start.
The only problem with this, is that under ERISA a “plan administrator” works for the insurance company and may deny your benefits even if your claim is a deserving one.
Long Term Disability Denial | How Can You Avoid Denial?
INSUFFICIENT MEDICAL EVIDENCE: One of the top reasons for denial is insufficient medical evidence. This can happen for a few reasons. Maybe you didn’t realize how important regular medical treatment would be for your case to be approved. If you have a physical ailment you should be seeing doctors regularly which would include testing such as x-rays, blood work, MRI scans or any other tests that would pertain to your physical condition. If you have a psychiatric condition, your insurer would expect you to have regular visits to a psychiatrist or psychologist monthly at the very least.
MISSING MEDICAL RECORDS: Sometimes a denial can occur because of missing medical records. Even when you provide all your medical records as evidence, the insurer may not have all of them in their files. Some persistence may be required, you or your attorney should ask for all medical records to ensure that all of them are in the possession of your insurance company.
DOCTOR’S STATEMENTS: Another and possibly one of the most important aspects of your case would be making sure that your doctor’s statements on your records are detailed. Often a doctor will state “doing fine” or “doing better”. This may be because your doctor is encouraged by you having a better day, but you could still completely disabled. To anyone reading the report, they won’t understand what this means. Be sure your doctor accurately describes your condition at each visit.