As lawyers representing disabled individuals with mental disabilities, we have seen firsthand the difficulties and challenges that these individuals face when seeking to obtain the benefits they are entitled to under the Employee Retirement Income Security Act (ERISA). One particular area that has been a source of frustration for many of our clients is the denial of group long-term disability benefits. In this article, we will provide an overview of the appeals process for denied group long-term disability benefits under ERISA and offer some tips on how to navigate this complex process.
Group long-term disability benefits are typically provided through an employer-sponsored group insurance policy. These policies are governed by ERISA, a federal law that establishes standards for employee benefit plans, including the procedures that must be followed when claims are denied. If an individual’s claim for group long-term disability benefits is denied, ERISA provides for a multi-step appeals process that must be followed before the individual can file a lawsuit.
The first step in the appeals process is to file an administrative appeal with the insurance company that issued the group policy. This appeal must be in writing and must be submitted within 180 days of receiving the denial letter. The appeal should include any additional information or documentation that supports the individual’s claim for benefits.
Once the appeal is submitted, the insurance company must review the claim and issue a decision within 45 days, with the possibility of a 45-day extension if additional information is needed. If the insurance company upholds the denial of benefits, the individual has the right to file a second administrative appeal, which must also be submitted in writing and within 180 days of receiving the denial letter.
In the second administrative appeal, the individual should provide any additional information or documentation that was not included in the first appeal, and may also request a review by an independent medical professional. The insurance company must review the appeal and issue a decision within 45 days, with the possibility of a 45-day extension if additional information is needed.
If the second administrative appeal is denied, the individual has exhausted all administrative remedies and may file a lawsuit in federal court. It is important to note that under ERISA, a lawsuit challenging the denial of group long-term disability benefits is typically limited to the administrative record, which means that the evidence presented during the administrative appeals process is generally the only evidence that can be considered by the court.
Navigating the appeals process for denied group long-term disability benefits can be complex and overwhelming, especially for individuals with mental disabilities. Here are a few tips to help make the process smoother:
- Seek the help of an experienced ERISA attorney. An attorney who specializes in ERISA can guide you through the appeals process and help you gather and present the evidence necessary to support your claim for benefits.
- Keep track of all deadlines. The deadlines for submitting appeals are strict, so it is important to keep track of when each appeal is due and to submit the appeal in a timely manner.
- Keep copies of all documents. It is important to keep copies of all documents related to your claim for benefits, including the denial letter, all appeal submissions, and any medical records or other evidence supporting your claim.
- Consider seeking support from a disability advocacy organization. There are many organizations that provide support and advocacy for individuals with disabilities, and they may be able to provide valuable resources and assistance during the appeals process.
In conclusion, the appeals process for denied group long-term disability benefits under ERISA can be challenging, but it is important for individuals with mental disabilities to pursue their rights and seek the benefits they are entitled to. With the help of an experienced ERISA attorney and by following these tips, individuals can increase their chances of success in obtaining the benefits they need and deserve.
Don’t go it alone! Contact Walker & Hern today for a free attorney consultation!