ERISA Disability Claims

Claims for short and long term disability benefits provided through an employee benefit plan are usually governed by the federal law known by its initials, “ERISA”—the Employee Retirement Income Security Act.

ERISA provides a legal framework for how the insurance companies who handle your claim must:

• Provide you with information about your benefits.
• Administer information and decisions on your claim in a fair and timely manner.
• Allow you a right to appeal or file a lawsuit to challenge a decision denying your claim.

Based on my more than 15 years of experience with ERISA disability cases in Dayton, Ohio, I believe most of the big insurance companies who handle these claims actually count on claimants not to challenge them when they deny a claim.

This disability claim system is governed by ERISA rules which the companies certainly know, but the unrepresented disability claimant usually does not.  The insurance company deciding your claim has access to large networks of medical professionals who make their living reviewing claim information and coming up with ways to say a claimant is able to go back to work—regardless of what your own doctor has said about your condition and your disability.

Obviously, insurance company decisions to deny benefits have a huge impact on claimants who find themselves not only unable to continue working and dealing with a serious health problem, but also suddenly cut off from a desperately needed source of income.