The Employee Retirement Income Security Act of 1974, or ERISA, is a law protecting Americans’ benefit funds by regulating how plans are managed and ensuring that consumer assets are not mishandled or misused. ERISA governs many types of funds, including retirement, health, life, and disability benefits.

What Protections Does ERISA Provide?

ERISA sets minimum standards for benefit accrual, funding, participation, and vesting, as well as establishing rules for plan sponsors regarding the disbursal of information to plan participants. ERISA also requires accountability from sponsors and plan fiduciaries, and grants plan participants the right to sue when their funds are mishandled or misused. Plan sponsors who violate ERISA may be held financially responsible for refunding plans and restoring losses sustained due to mishandled funds.

Patients whose long term disability plans are covered by ERISA are entitled to be notified of their coverage and benefits and informed on how to file a claim. Additionally, employers may not fire or discriminate against employees for filing a long term disability claim.

How Does ERISA Affect Long Term Disability Plans?

According to the U.S. Department of Labor, employees who have long term disability plans under their employers are governed by ERISA in many ways, including:

• When benefits are denied, the claimant must be allowed to appeal the decision. Claimants must be given at least 180 days to do so.
• When long term disability benefits are denied or terminated, the plan is required to provide claimants with copies of their documents and records.
• When claimants have exhausted all appeals, they may file a federal lawsuit, although they are prohibited from seeking bad faith damages or damages for pain and suffering.

Claimants who have been denied long term disability benefits may be able to hire an attorney and file amn ERISA lawsuit to pursue owed benefits and compensation.

Why Are Long Term Disability Claims Commonly Denied?

Long term disability claims may be denied for many reasons, including:

• Doctor evaluations: Patients are often required by insurance carriers to submit forms from their doctors documenting the level of disability. However, the forms that many insurance companies have for this purpose are designed to elicit responses that would support the denial of the patient’s claim.
• Failure to receive regular treatment: Patients who apply for disability are expected to receive regular medical treatment, including objective diagnostic tests such as x-rays and MRIs. Patients who do not attend regular doctor appointments may have claims denied.
• Missing medical records: claims are often denied due to a lack of medical records. Patients are encouraged to ensure that their records are sent along with their claims or appeals.
• Missed due dates: Patients who submit claims or file appeals past the due date may not be able to pursue further disability benefits. Filing claims in a timely fashion is very important to patients hoping to receive benefits.

What Can Patients Seeking Disability Benefits Do?

Many insurance companies hire investigators to conduct surveillance on people who have applied for long term disability benefits, in order to determine whether their claims are false. Video and photo surveillance is especially common in cases of conditions like fibromyalgia, which cannot be diagnosed with concrete tests such as MRIs or x-rays. Patients who suspect they may be surveilled during their disability claims or appeals process should follow their doctors’ orders regarding any physical limitations. Patients who suffer from some chronic conditions may experience a fluctuation in symptoms. However, even if they are photographed or videotaped on a day when they are feeling good, any surveillance may be used as evidence to deny the disability claim.

ERISA regulations are complicated. Having a qualified attorney on your side may make the legal process easier for you to navigate if you are applying for disability benefits or appealing a denial of benefits.

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.

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