If you can’t work due to an injury or disability, you may be eligible for disability payments. Filing for disability in Ohio isn’t always easy. The insurance company may deny your eligibility for several reasons, some of which aren’t accurate. Use this guide to prepare for your disability hearing to increase your chances of approval.
What Is ERISA?
The U.S. Department of Labor passed the Employee Retirement Income Security Act (ERISA) in 1974 to help protect workers. If you cannot work due to an ongoing health issue and receive disability insurance through your employer, your health insurance company must provide benefits.
However, insurance companies sometimes quickly push back and deny your claim so they don’t have to pay. The ERISA plan covers employer-sponsored benefits such as retirement, disability, and health insurance. The plan aims to protect employees and their families. ERISA covers work-sponsored plans by most private employers. While ERISA laws cover many employer plans, the most common case is for disability.
It’s important to note that some employees, including government and religious organization workers, aren’t eligible for ERISA.
How Can I Improve the Chances of an Approved Disability Claim?
One of the best ways to improve your chances of an approved disability claim is to hire a disability lawyer. You should also ensure your application is complete and includes all requested documents. It’s usually better to include more documents than you need than not enough. The appeals process doesn’t allow you to add more evidence at a later date.
Gathering your information ahead of time can make filing more accessible, including your medical records, physician statements, work statements, and bills. In the meantime, make sure you continue following your physician’s recommendations. Keep track of all updated medical records and seek consultation from a specialist when you’re requested to do so.
Of course, sticking to timelines is also essential to ensuring you continue being eligible for disability benefits. Failing to meet specific time limits can make you ineligible for benefits.
What Is the ERISA Claims Process?
Filing an ERISA claim requires a series of forms and records. You’ll also have to request that your primary physician and employer sign some of these forms. After you submit your application, the insurance company begins its investigation. In some cases, this may include a physician visit with a doctor of their choice. The insurance company has up to 105 days to approve or deny your claim. However, they can also request an extension.
It’s not uncommon for insurance representatives to deny a claim. Many filers have come to expect a denial on the first filing. Working with a disability lawyer on your first filing, however, can increase your chances of an approved claim.
What Happens if Your Disability Case Is Denied?
Under ERISA, you have 180 days to file an appeal following your denial. The insurance company then has 45 days to determine the appeal request. Some filers may also request a second appeal, which extends the timeline further. If you want to collect disability, an appeal is a must.
The strict timeline is just one of the reasons why you’ll want to contact an ERISA disability lawyer as soon as possible after being denied. Your lawyer will communicate with the insurance representative to determine why you were denied. Then, they’ll help build your case, including medical statements, expert testimonials, medical records, and work history.
The insurance company must provide a letter explaining why they denied your benefit eligibility. Failing to meet the strict timeline is one of the reasons why you could receive a denial; there isn’t anything you can do about this. After appealing, a judge will review your case and include documentation. Disability appeals and lawsuits don’t receive a trial.
What Happens if You Lose Your Appeal?
Following another denied appeal, your only option is to file a lawsuit under ERISA. This requires the expert knowledge and services of an ERISA lawyer. The lawsuit aims to receive disability benefits, back-owed benefits, and attorney fees. Restitution and punitive damages aren’t available through an ERISA lawsuit.
ERISA was put in place to protect employee disability benefits. If you’re injured, you’re subject to the disability insurance benefits available through your employer. Filing a disability claim isn’t always easy; many applicants can expect a denial. Appealing the decision requests that the insurance company take another look at your case. Working with an ERISA lawyer throughout the appeals process can benefit you in many ways, including helping you adhere to strict timelines.
