ERISA, or, the Employment Retirement Income Security Act, is a law passed in 1974 to attempt to establish basic requirements for most private insurance and retirement plans and protections for consumers. It was first written to apply primarily to pensions, but it was extended to include nearly all benefits offered by private employers, including health plans, life insurance, and long-term disability benefits.
Despite its primary intention being to provide protection for consumers, the act brought its own fair share of difficulties and complicated challenges to individuals trying to get their benefits. It also has the effect of overriding many other laws on the books concerning health and disability insurance through your employer. That’s why it’s important for you to be sure you know how the system works to ensure you get the benefits you deserve and have your claims recognized. Here are some practical tips that can help you deal with the insurance company and avoid unnecessary setbacks.
ERISA mandates that insurance companies develop a comprehensive appeals process for clients that aren’t happy with the compensation they’ve received. You’ll have to go all the way through that appeals process before you can seek legal action against the company. You also need to be sure your final appeal includes all of the relevant evidence for your claim that you can find. Anything not included in that appeal won’t be able to apply as evidence in a case against the company afterward.
The insurance company is not going to find all the evidence for you. It’s entirely your responsibility to substantiate your claim and prove that you deserve the disability or insurance payments. From the beginning, you should document your costs and get statements from relevant people that can corroborate. You may have to prove later on that you presented that information to the insurance company, so you should keep a careful record of that as well. It’s also essential that you have medical records of your injury or disability from a suitably qualified medical professional. A valid medical evaluation of your condition will go a long way toward helping your claim.
Tell the Truth
You earned the right to your benefits through the work you did and the payments you made through your employer. All you’ve got to do is prove that and document the facts of your condition showing that you deserve those benefits. If you have a long-term disability, don’t feel embarrassed or self-conscious about it. You worked hard and you need to be honest and thorough in explaining the extent of your disability. If you’re not thorough from the beginning, you might not have a chance to do so later.
You also shouldn’t exaggerate any details about your condition. You may still deserve benefits, even if you think your injury or disability may not be that significant, and the truth will come out eventually if you try to make things seem worse than they are. It’s natural to feel defensive when the insurance company is skeptical about your condition and tries to minimize your symptoms, but you need to ignore them and stick to the truth. It may take some time, but if you’re determined and well-informed, you’ll get the benefits you’ve earned in the end.