A long-term disability can take a serious financial toll on a person and their family. Long-term disability insurance helps to relieve the pressure. Many people who have coverage obtained it through their employer or their spouse’s employer. All employer-backed long-term disability plans are governed by a federal law called the Employee Retirement Income Security Act (ERISA). 

 

ERISA disability claims are complicated. At The Law Office of Paul J. Dombeck, PLLC, we are committed to helping clients effectively navigate the claims process so that they can secure the financial support they need. Within this article, our Phoenix ERISA lawyer highlights the essential strategies to help you maximize your benefits in a long-term disability claim.

 

Strategy #1: Understand ERISA and the Role of ERISA Regulations in the Claims Process

 

ERISA is a comprehensive federal statute that governs employee benefit plans, including long-term disability (LTD) benefits. To maximize your long-term disability benefits through an ERISA plan, it is crucial to have a solid understanding of how regulations shape the claims process. The background knowledge will help you navigate all relevant procedural requirements. A key point to understand is that ERISA standardizes disability claims. It is designed, in part, to ensure that the process is fair for people. At the same time, ERISA is a highly complex federal law. Insurance companies are staffed by trained professionals who have a deep understanding of ERISA regulations. You should not hesitate to seek help with your ERISA claim. 

 

Strategy #2: Seek Prompt Medical Attention, Get Follow-Up Care, Preserve Records

 

If you have a serious injury, chronic illness, or any other type of significant medical impairment that is a long-term disability, you need to seek the proper medical care. Timely medical attention is not only vital for your health, well-being, and physical recovery, but it also plays an important role in the ERISA disability claims process. Further, consistent follow-up care demonstrates the ongoing nature of your condition—which is critical for substantiating your claim. Be sure to preserve all relevant medical records. Your medical documentation will support your claim of a long-term disability. Indeed, most ERISA disability cases turn on the medical evidence. You should be prepared to prove both the existence and severity of your disabling medical condition. 

 

Strategy #3: Submit Your Long-Term Disability Claim in a Timely Manner 

 

Once you have developed a medical disability that prevents you from working on a full-time basis, you need to file for benefits as soon as possible. Not only do you want to get any financial benefits that are available to you as soon as possible, but a late submission could potentially jeopardize your long-term disability claims. ERISA regulations often impose strict deadlines for filing, and missing these deadlines can result in losing your rights to benefits. Be proactive. If you have any questions about preparing/submitting an initial application for benefits, an ERISA lawyer can help. 

 

Strategy #4: Fight Back Against a Denial (Review the Letter, Get Your Claim File)

 

Was your long-term disability claim denied in Arizona? ERISA provides all workers covered by policies the right to appeal a denial. Neither your employer nor its insurance company gets to make a unilateral final decision on your long-term disability benefits. The first step in challenging a denial is to carefully review the denial. By law, that letter will outline the reasons for the decision. However, in practice, ERISA disability denial letters are often full of industry jargon. They can be difficult to parse. Your letter should be reviewed by an attorney. Understanding the reasons for the denial will be key to building a strong appeal. Beyond the denial letter, request a complete copy of your claim file from the insurance company. The file contains all the evidence used in making the decision to deny. With it, your lawyer can identify any gaps that can be addressed in your appeal.

 

Strategy #5: File an Administrative Appeal Within 180 Days (Include Supporting Evidence)

 

You cannot immediately take an ERISA long-term disability claim to court after getting a denial letter. The first stage of the appeals process is an administrative appeal. An administrative appeal is a formal process in which a claimant challenges the denial of their benefits directly to the insurance company. In other words, the insurance company will take a second look at your claim. You can and should include additional supporting evidence during this stage of the process. The U.S. Department of Labor (DOL) explains that claimants must appeal an adverse benefits determination—including a denial of long-term disability benefits—within 180 days. What happens if you fail to take action in a timely manner? You could lose out on your ability to appeal at all. 

 

Strategy #6: Take Your Claim as Far as Needed to Maximize Your Disability Benefits

 

In some circumstances, an administrative appeal may be sufficient to get your long-term disability benefits. Unfortunately, that is not always the case. You have options available to escalate your ERISA appeal. If your appeal is denied, it is important to be prepared to take your claim further. If your claim is denied a second time, you may need to pursue federal litigation in order to maximize your long-term disability benefits. Indeed, an insurance company can be sued after all administrative remedies—including the administrative appeal—have been fully exhausted. A top-tier Phoenix disability lawyer can review your case and help you develop a plan to secure the best possible outcome. 

 

Schedule a Free Consultation With Our Top-Rated Phoenix ERISA Attorney Today

 

At The Law Office of Paul J. Dombeck, PLLC, our Phoenix long-term disability attorney puts the rights and interests of clients first. If you have any specific questions or concerns about pursuing benefits through an ERISA claim, we are here to help. Give us a call now or contact us online for a free, no-obligation review and evaluation of your case. With an office in Phoenix, we provide ERISA disability representation in Maricopa County and throughout the region.