What You Should Know About ERISA Claims

You might not know about the acronym ERISA, but if not, it is high time you learned. ERISA means the Employee Retirement Income Security Act. The federal government enacted it back in 1974, and it has proven valuable for workers since then.

Essentially, it is a federal law that establishes minimum amounts that health plans or voluntary established retirement plans should provide for the individuals they cover. It protects the individuals who use these plans, and it’s a way of standardizing care.

Let’s talk about the ERISA law a little bit more right now.

Pension Reform

Some people also call the ERISA Act the Pension Reform Act since part of what it does is establish standardized pension aid amounts for disabled persons. If you’re newly disabled and you’re getting ready to file one of these claims, you might want to hire an ERISA lawyer. Some attorneys specialize in these claims, and you may want one on your side since the filing process is sometimes a little tricky.

The main thing you should know about the ERISA law is that it does not actually guarantee you long-term disability benefits if you hurt yourself or get sick. You can probably get your benefits, but there are some exceptions, and there’s also usually a mountain of paperwork that you’ll have to navigate.

ERISA Disability is Not the Same as a Privately-Purchased Disability Insurance Plan

If you’re going about this process, you should also know that ERISA is not the same as a disability insurance plan that your workplace purchases. Federal regulations and law govern ERISA, but not private insurance. There are some rules private insurance companies must follow, but they are not the same as those the federal government set up for ERISA.

You’ll Need to Look into Your Plan Specifics

As you prepare yourself to file your claim, you’ll need to study your plan’s specifics. It’s often helpful to have an attorney at this stage since the legalese involved in some of the documents can make your head spin.

Federal minimum requirements exist that govern how much you should get, but no two plans are identical. Every plan has rules you’ll need to follow very strictly if you’re going to cash in.

Your employer should give you a booklet that talks about your plan’s details. If it does not answer all your questions, you might speak to HR about it. They may be able to answer some of your questions, but if they can’t, you can go online and probably find further details there.

Your Specific Disability

The key to getting paid through these plans is whether or not your specific disability qualifies. You will probably have to get doctor-issued documentation stating that you have the condition, whatever it is.

You will need to allow the company that issued the policy to view your medical records as well.

Every plan has a slightly different definition of terms like “disabled” and “disability.” It’s possible that even if you have a condition that stops you from working the way you once could, the company might try to quibble about whether what you have qualifies.

There is potentially a lot of money on the line, and the companies that offer these plans are for-profit entities. It should not surprise you if they try to fight you if they feel like your condition does not meet their “disability” qualifications.

How to Have the Best Chance of Filing a Successful Claim

If you can do as much research as possible about your specific condition and the plan itself before you file, that will likely benefit you. You should also try to get as much physical documentation regarding your situation as you can. Multiple doctors agreeing that you can’t work instead of just one can definitely help you.

You should also keep every communication you ever have with the insurance company. That way, you can simply refer back to it if they say they told you something or mentioned something to you, but they never did. Again, it’s upsetting to think the insurance company might resort to these tactics, but it happens more often than you might think.

The Insurance Company Will Have an Eye on You

Once you get into the claim process, expect that the insurance company will have people watching you as well. That person you think is following you on the street might actually be doing so.

This is because the insurance company will want to try and prove that you’re not as disabled as you claim. They are constantly on the lookout for fraud. As long as you don’t do anything that contradicts your claim status, you should be fine.

Don’t ever try and sneak something past the insurance company, though. If you claim to be more disabled or ill than you are, you can face some steep penalties for that. You might not only lose the claim but face criminal charges if you intentionally commit fraud during this process.

What if the Company Denies Your Claim?

In the event that you put in a legitimate disability claim according to the ERISA-established rules, and you have that condition, you should get your money. If the insurance company tries to fight you over some technicality, though, that’s when you might have to head to court and battle it out in front of a judge.

Most people don’t like to be litigious, but this is one instance where you may have to be. Even if you didn’t want to hire an attorney before, now you might have no alternative.

The process at this point might consume much of your time, but if you need that money the insurance company can provide you, and you’re certain you meet the disability standard their policy set, there’s no reason not to proceed. Hopefully, your lawyer can convince a judge that your disability is legit, and you can collect the money to which the ERISA law and the specific insurance policy entitles you.