Being unable to work because of an illness or injury is something many in California do not like to consider. However, those with foresight plan for that possibility by adding long-term disability to the insurance benefits they obtain through their employers. Because these policies are often offered as part of an employee benefits package, they are usually subject to ERISA (the Employee Retirement Income Security Act), which governs most employee benefits litigation. ERISA and the associated Department of Labor regulations also govern the process of administratively appealing the denial of a claim for disability benefits which is normally required prior to a lawsuit being filed.
After planning ahead and purchasing LTD insurance, it can be discouraging if the insurer denies the claim. At that point, the claimant is likely suffering physically, emotionally and financially, and challenging the denial can be a struggle. Nevertheless, ERISA requires that the claimant administratively appeal the denial to the insurance company or plan administrator prior to bringing a lawsuit to seek the benefits at issue in state or federal court.
The reasons for denial of a claim for benefits vary but it is not uncommon for the insurance company to base its denial upon an error on the claimant’s application or the alleged failure to provide enough medical support for one’s claim. This is why many people wisely seek the assistance of an attorney from the very beginning of the claims process.
When faced with a long term disability claim denial, a claimant in California should be prepared for a difficult battle if he or she intends to appeal, and if necessary, proceed with filing a lawsuit.
An attorney who has experience with disability law and ERISA governed disability plans will often provide you with the best chance for a successful outcome. This will allow a claimant to focus on his or her health and recovery, rather than fighting with an insurance company.