When workers become disabled, they need to file a disability insurance claim in order to receive the benefits promised to them under the terms of their insurance plan. However, in some cases, people may find that their insurance claim has been unfairly denied—in response, they may be able to file an ERISA lawsuit in order to be granted their rightful benefits.

What is ERISA?

Under the Employee Retirement Income Security Act (ERISA), established in 1974, certain employment benefits are protected by a set of rules and regulations. Qualified retirement plans have to follow ERISA rules in order to make sure that those in charge of managing assets (known as fiduciaries) do not neglect, exploit, or otherwise mismanage plan assets. Other rules govern health plans and long-term disability insurance plans that are sponsored by employers.

Does ERISA Cover My Disability Plan?

ERISA covers some but not all disability plans. ERISA is specifically for voluntary, private disability insurance provided to employees by the company. In most cases, employer-sponsored group plans are covered by ERISA.

Is My Injury/Illness a Disability?

Each individual disability plan will have very specific requirements for what is considered a qualified injury, disease, or illness. Generally, a disability is a condition that impairs or completely eliminates a person’s ability to work.

Plans may also specify certain exclusions for types of conditions that the insurance does not cover. In some cases, plans may exclude certain injuries like those caused by elective surgery, cosmetic surgery, self-inflicted injuries, or injuries suffered as a result of committing a felony.

Short-Term vs. Long-Term Disability: What’s the Difference?

Short-term disability benefits provide coverage for temporary illness or injury that prevents a person from being able to work, typically between three and six months. Long-term disability benefits apply to situations in which a person suffers from disease or serious injury that prevents them from being able to work for a period of many months or even years.

Some injuries may prevent a person from ever returning to work at all. Long-term disability benefits can last until the person reaches the age of retirement. Employers can either offer short-term disability, long-term disability, or both.

Does Pregnancy Count as a Disability?

While pregnancy is neither a disease nor a disability, some workers on maternity leave may qualify for short-term disability benefits. These short-term benefits can help to partially cover the worker’s salary during pregnancy, childbirth, and the recovery period thereafter in which they are unable to work. Coverage of pregnancy leave varies in individual plans.

My Claim Was Denied. What Can I Do?

When a person’s disability insurance claim is denied, the insurance company is required to provide the specific reasoning for the denial, as well as included information on how to file an appeal. When profit is the alleged motivation for denial, this is often known as bad faith insurance.

Generally, employees have 180 days to file an appeal. Many people choose to consult an attorney before filing an appeal to help guide through this complicated process and ensure the appeal and additional supporting evidence are as thorough as possible.

My Appeal Was Denied. Is That It?

If your appeal was denied, don’t worry—all is not lost. At this point, you may be able to pursue legal action against your insurance company under ERISA. Hundreds of cases have been filed against Unum, for example, as the largest provider of disability insurance in the country.

Filing an ERISA lawsuit can help recover damages including disability benefits (reinstatement of future benefits as well as payment for past benefits), along with legal costs. While any ERISA lawsuit has the potential to move all the way to trial, most of these cases are resolved in some kind of settlement before they make it to the trial stage.

How Could an Attorney Help?

Filing an ERISA lawsuit can be overwhelming, especially while also dealing with a debilitating disease or injury, so Top Class Actions has done some of the work for you by connecting you with an experienced ERISA attorney. Consulting an attorney can help you determine if you have a claim, navigate the complexities of litigation, and maximize your compensation.

Do YOU have a legal claim? Fill out the form on this page now for a free, immediate, and confidential case evaluation. The bad faith insurance attorneys who work with Top Class Actions will contact you if you qualify to let you know if an individual lawsuit or Unum class action lawsuit is best for you. [In general, Unum bad faith lawsuits are filed individually by each plaintiff and are not class actions.] Hurry — statutes of limitations may apply.

Learn More