The Difference Between ERISA and Non-ERISA Disability Claims
Your legal options after having a disability claim denied are dependent on your insurance coverage. Significant differences in the two basic long-term disability insurance plans will determine how to dispute a denied disability claim. Bad faith insurance practices in Arizona and California can impact your ability to receive compensation.
Types of Long-Term Disability Insurance
Appealing a denied disability claim will require you to know what laws apply. The appeals process can be complex and frustrating, proving beneficial for the insurance companies and financially devastating to those unable to work. Two types of basic long-term disability insurance are available:
- ERISA: Disability insurance provided by an employee benefit plan governed by federal law under the Employee Retirement Income Security Act (ERISA) of 1974
- Non-Erisa: Individually purchased private insurance policies
ERISA determines the guidelines an employer and an insurance company must follow under federally-guided plans. They also establish legal requirements for dispute resolution when the insurance company denies a disability claim. The federal laws governing setting the legal framework of these disability policies are applicable in every state. Contact a long-term disability attorney from Dawson & Rosenthal to learn more.
Appealing ERISA and Non-Erisa Disability Claims
The information federal law requires the insurance company to provide you about your disability claim strives to ensure a claim’s fair review. Appealing a denied disability claim in federal court is the next step when you and your denied disability claim lawyer in Arizona or California disagree with the insurance company’s ruling. State laws govern non-Erisa disability policies and often differ from state to state. You still have legal options available when you do not agree with a disability ruling. Non-ERISA claims may allow you to take action sooner in state court instead of following the staunch guidelines under federal laws. Filing a lawsuit may be possible when your claim has been wrongfully denied. You may also qualify for punitive damages in specific incidents.
What to do if Your Disability Claim is Denied
You may legally appeal a denied disability claim despite the plan. Because of the complex state and federal laws that apply to disability coverage, seeking legal guidance can help identify insurance company tactics in denying disability claims, allowing you to fight back effectively. Missing critical deadlines or making an error in your appeal may create unnecessary delays in potential compensation or, even more impactful, prevent you from having your disability claim approved at all. Despite having an individual disability insurance policy or receiving coverage under an ERISA policy, three types of coverage likely apply. A disability approval is guided by the kind of coverage, including:
- Own occupation: Coverage is available if you cannot perform your current job assignment. Benefits may still be available if you can perform another job, but performing your current job’s functions is not possible.
- Any occupation: Coverage benefits are available when you cannot perform any job. Income qualifiers may also apply.
- Own and any occupation: Both types of coverage apply and will take effect at various stages, depending on your ability to perform your job or if you remain unable to perform any work.
Filing a disability claim and getting approval is critical to financial stability. Accurately filing and appealing a disability claim strives for a smoother process, ensuring you receive the coverage you need and deserve. Learn more about filing a disability claim and how to appeal a denial.