Challenges with Long-Term Disability Appeals in Maryland
It is reassuring to know that your employer-provided long-term disability benefits cover you if you suffer from a medical condition and cannot work. However, the fact that you have coverage under a policy does not automatically mean you will start receiving checks. These plans must comply with the Employee Retirement Income Security Act (ERISA), so the insurance company will carefully review your claim. There are strict rules about the process and criteria, but the insurer may still deny benefits on various grounds.
In such a case, you will have to pursue a long-term disability appeal. This stage does not involve going to court, because there are requirements before you can sue the insurance company in a lawsuit. Instead, after a denial, you can move on to administrative remedies. It is smart to trust a Maryland long-term disability attorney for help, but an overview about LTD appeals is also useful for understanding the basics.
Exhaust Administrative Remedies: In short, this term means you need to pursue all options that are available to you through the LTD insurer’s administrative appeals process. All long-term disability policies permit at least one appeal, in which you present your case by submitting additional evidence and argument to support your claim and contest the insurance company’s denial.
ERISA requires that you go through this process to overturn a wrongful denial of LTD benefits. Once you do exhaust all administrative remedies, you receive notice that you are allowed to sue.
Challenges with Long-Term Disability Appeals: There are some ERISA rules that favor insurance companies, so you must be prepared for pitfalls:
- The standard of review that applies in many lawsuits is termed abuse of discretion. Essentially, this assumes that the insurer made a proper decision in denying your claim. To address this issue, you will need to show that the decision was unreasonable under the circumstances.
- ERISA rules require you to submit all information related to your claim at the time you file your LTD appeal. You are not permitted to add records to your claim, so you cannot correct errors and omissions later.
- The deadlines for appealing the insurance company’s denial are somewhat short, so quick action is necessary. You will receive a notification about the time restrictions for filing an appeal through the administrative process. Usually, the deadline will be 180 days from the date of denial.
Considering the fact that you must have all evidence gathered and organized within this timeframe, it is crucial to get started with the LTD appeals process right away.
Get Legal Assistance from Our Maryland Long-Term Disability Lawyers
You can see that help from an attorney is critical to overcoming the challenges that could defeat your LTD appeal. Legal support is essential when you are in dire need of financial benefits. For more information, please contact the Law Offices of Steinhardt, Siskind and Lieberman, LLC. We can set up a free consultation with a Maryland LTD attorney who will explain the process and what to expect.
Source:
dol.gov/general/topic/health-plans/erisa
