WHAT YOU NEED TO KNOW ABOUT ERISA
Empowering Your Fight for Fairness
ERISA law is governed by Federal Statutes and was established to set guidelines for employers to help protect employee’s benefits, such as disability, sickness and health concerns, retirement, welfare and other employment-related benefits. The legal guidelines are set forth in the Employer Retirement Income Security Act of 1974, otherwise known as ERISA (found in U.S. Code Title 29, Chapter 18). The application of ERISA is not an easily understood process. Unfortunately, many insurance companies fight against paying the benefits they owe at a time when people are most vulnerable, distraught and most likely to make mistakes.
Many people make the mistake of applying for disability benefits without thoroughly consulting their policy first. Your disability policy generally differs from other insurance policies, so it should be carefully reviewed. Your policy will define what your carrier considers to be disabled, how your benefits will be calculated, limitations on benefits, and most importantly crucial deadlines, just to name a few.
A person must file an initial claim with the insurance company. A representative (a claims adjuster) will review the claim and make the determination to either pay or deny your benefits under the policy. If your claim is denied, you must file an appeal before a lawsuit can be filed. Missing a deadline or waiting too long to get help can mean the end of your claim. If a person accepts the decision denying the claim they will not receive any of the benefits they are owed at a time they need it most. If a person appeals the decision within the appropriate time frame they can have the insurance company review the claim again.
Every person is entitled to know what is contained in their claim file. The claim file is critical, because it is what the insurance company relies upon in making their determination about your claim. Before you appeal the denial, every person should attain a copy of the claim file from the carrier. It contains all the evidence the insurance company has to date, and what information they have gathered about you, including your medical records, the insurance companies own evaluations, surveillance if any, telephone call records, and a lot of other important information. In ERISA claims, this claim file will be the ONLY evidence a judge will look at to base their decision upon if you file a lawsuit. It is vital to know what is contained in your file. The claim file becomes the record for any potential lawsuit, so if you have not submitted the proper evidence, or the evidence is not in the file, you will lose and be denied the rightful benefits you are owed.
