There are numerous ways for someone in California to protect him or herself from financial hardship in the event of a catastrophic illness or injury. When these events require a worker to take a significant amount of time off work, unpaid sick days are usually not enough to support the family during recovery. Some workers are fortunate that their private employers offer long-term disability insurance as part of their benefits package. Under most circumstances, these benefits are governed by ERISA - the Employee Retirement Income Security Act of 1974.
If you have long term disability coverage under an ERISA-governed plan, you would be wise to take steps to gain a thorough understanding of the often-confusing rules ERISA mandates regarding how these types of claims work.
For example, if an employee files a claim for benefits, the insurance provider has a limited amount of time to determine whether it will approve the claim. ERISA also requires that a plan participant whose claim for LTD benefits is denied must receive a written explanation setting forth the specific reasons for the denial. There are also rules which, in most cases, require that the claimant go through an appeals process with the insurance company prior to filing a lawsuit for benefits.
After the denial of an appeal, an employee may file a lawsuit. These cases usually wind up in federal court and are decided by a judge rather than a jury. Live testimony is rarely allowed. Consequently, one of the major factors in winning these cases is whether or not you have provided the insurance company with substantial and adequate documentation of your disability during the appeals phase of your claim.
Because of ERISA's complicated rules, navigating a long-term disability insurance claim is often tricky from the very beginning. Fortunately, there are attorneys in California who are experienced in dealing with the process - from the initial application, to administrative appeals and through lawsuits. Having such a legal professional as an advocate will usually be a huge benefit for any employee seeking to successfully navigate this complicated area of the law.