The Employee Retirement Income Security Act (ERISA) is an important federal law that is designed to help ensure that worker benefits are properly protected. Notably, employer-sponsored long-term disability plans in Arizona are generally regulated by ERISA. The law has major implications for your rights and your responsibilities if you are making a claim for disability benefits. Our Phoenix ERISA attorney can be a guide to long-term disability in Arizona. 

What is the Employee Retirement Income Security Act (ERISA)?

The Employee Retirement Income Security Act (ERISA) is a comprehensive, 1970s federal law that regulates most employer-sponsored benefit plans, including long-term disability (LTD) insurance. Here is a key point for employees in Arizona to know: ERISA establishes strict rules for how claims must be filed, reviewed, and appealed. Along with other things, it requires that plans provide participants with specific disclosures, including a summary plan description (SPD) and details about claim procedures. 

Note: ERISA preempts most state law remedies. In other words, employer-sponsored long-term disability plans in Arizona are generally governed by federal law. 

Common Challenges Employees Face in ERISA Disability Cases 

A serious injury, illness, or other medical complications can be challenging to deal with. Workers in Arizona can face a number of different struggles in getting their ERISA disability benefits paid out. Here is an overview of some of the most common challenges that workers face: 

• Strict Deadlines: One big challenge is that the deadlines are extremely strict. Indeed, ERISA imposes very short deadlines for filing claims and for filing appeals. Timing matters. Missing a deadline can permanently bar a long-term disability claim. 

• • Limited Evidence Record: Another challenge is that once an initial claim and appeal are complete, federal courts will generally review only the administrative record. Any evidence not submitted during the claim or appeal cannot be introduced later. It is a problem because employees often fail to include full medical documentation before the record closes.

• Insurer Bias is a Big Problem: The insurance company effectively runs the early stages of the ERISA long-term disability process. Indeed, insurance companies act as both claim evaluators and payors. By definition, that creates an inherent conflict of interest. Courts recognize the bias but still defer heavily to administrators. 
• Ambiguous Plan Language: Plans often contain vague or technical definitions of “disability.” Administrators interpret these definitions narrowly to deny claims. Employees may not understand how terms such as “own occupation” or “any occupation” apply to their situation. Too many plan administrators are not on the side of claimants. 

Key Things to Know About the Legal Process for Filing a Claim and/or An Appeal

ERISA Disability Claims

The ERISA long-term disability claims process begins when an employee submits a written claim for long-term disability benefits. The claim must include medical evidence, employment information, and supporting documentation required by the plan. Plan administrators typically have 45 days to issue a decision, but they are subject to limited extensions. If approved, benefits are paid according to the terms of the policy. If denied, the administrator must provide a written explanation, including reasons for denial and reference to the plan provisions relied upon. The initial claim stage is critical because it creates the foundation for your entire claim. 

ERISA Disability Appeals

Denials happen. Too many employees in Arizona struggle to get access to the full and fair long-term disability benefits that they are entitled to under their plan. If a claim is denied, employees have the right to file an internal appeal with the plan administrator. The appeal must be submitted within 180 days of the denial notice. To be clear, it is the final opportunity to supplement the record with medical evidence, expert opinions, and witness statements. Plan administrators must issue a decision within 45 days, with limited extensions allowed. If the appeal is denied, the claimant may file a lawsuit in federal court. Remember, judicial review is generally limited to the administrative record. A top-tier Phoenix, AZ long-term disability attorney can help. 

How an Attorney Can Help Protect Your Rights Under ERISA

As an employee who is navigating an ERISA disability claim, you may face some major procedural and substantive obstacles. Professional guidance and support can make a big difference. Insurance companies are not on your side. An experienced Phoenix, AZ ERISA attorney provides critical support in several ways. To start, your lawyer can review the plan documents and explain the specific definitions and requirements that govern eligibility. Beyond that, your Phoenix, AZ long-term disability attorneys help gather comprehensive medical and vocational evidence to strengthen the claim record. Finally, your lawyer will ensure that appeals are timely filed and that the record is fully developed before it closes. A proactive approach is a must. 

The Law Office of Paul J. Dombeck is a Leader in ERISA Disability Claims

ERISA disability cases are complicated. If you are an employee who has a long-term disability because of an injury, illness, or other medical complication, it is imperative that you are able to secure the full and fair financial support that is available under the law. ERISA provides some important legal protections, but it is also a federal law that is notoriously difficult for individuals to navigate. At The Law Office of Paul J. Dombeck, we have extensive ERISA experience. Our team will protect your rights and help you secure the maximum available benefits. Your initial consultation with our Phoenix disability lawyer is free and fully confidential. 

Call Our Phoenix, AZ ERISA Disability Attorney Today

At The Law Office of Paul J. Dombeck, PLLC, our Phoenix long-term disability attorney has the knowledge and experience to handle ERISA cases. If you have any questions or concerns about an ERISA disability claim, we can help. Contact us right away for a free, no-commitment case review. It is our mission to help you maximize your benefits. With an office in Phoenix, we handle ERISA disability claims in Maricopa County and throughout Arizona.