What Does Exhaust Administrative Remedies Mean For Long-Term Disability Claims?

Long-term disability insurance is a valuable employment perk that pays benefits if you suffer from a disabling medical condition and are unable to work. Not all Maryland employers offer long-term disability (LTD) insurance, but companies are bound to the requirements of the Employment Retirement Income Security Act (ERISA) when they do. Plan administrators must provide participants with requests for information, set clear rules on vesting, and establish a prompt, fair process for participants to file benefit claims.

In addition, there are ERISA regulations that apply if your LTD claim is denied after your initial application. Plans must incorporate a grievance and appeals process for participants to contest the denial. When your claim is covered by ERISA, you must follow this process before you can file a lawsuit in court. The reason is a rule termed “exhaustion of administrative remedies,” which your Maryland long-term disability attorney can explain in detail. Some background information will help you understand the basics.

ERISA Rules on Exhausting Administrative Remedies: With many laws, you can go directly to court when someone violates your rights or causes losses. Other statutes require you to take advantage of options that are overseen by an administrative body instead of a court. When a long-term disability insurance plan is covered by ERISA, a participant must go through these proceedings. Just as ERISA mandates that insurers establish an appeals process, it also mandates that employees exhaust administrative remedies.

Fortunately, many LTD claims are resolved through the insurance company’s administrative appeals process. You will not need to go to court. However, if you follow all requirements and go through all steps as required by the insurer, you could still be denied. The insurance company will forward a letter stating the denial, and this is your evidence that you exhausted administrative remedies – setting the stage to sue in court.

 How to Exhaust Administrative Remedies: The requirement to pursue administrative options is triggered when the insurance company issues its initial denial letter. At this point, you are entering the appeals process for an LTD claim. Your long-term disability attorney will manage all details, but the important tasks for proceeding with administrative remedies include:

• Carefully review the denial letter. It will include information on why your claim was denied, and you may need to just correct mistakes or provide additional documents.
• Request your claim file from the LTD insurer. This paperwork may offer additional details on the grounds for denying your claim.
• Provide meticulous, detailed documents to support your appeal. You will not have the opportunity to submit additional paperwork after the administrative process. If you omit key facts at this stage, you will not be able to correct mistakes later.

Get Legal Help from a Maryland Long-Term Disability Lawyer

Exhausting your administrative remedies is a requirement under ERISA, but you can trust the Law Offices of Steinhardt, Siskind and Lieberman, LLC to handle the complexities. For personalized details about LTD claims, please contact our firm to schedule a free case review. After evaluating your situation, a long-term disability attorney can advise you on next steps.

Source:

dol.gov/general/topic/retirement/erisa#:~:text=The%20Employee%20Retirement%20Income%20Security,for%20individuals%20in%20these%20plans