ERISA, the Employee Retirement Income Security Act of 1974, is a complex Federal law that applies to most types of employee benefits.  This often includes claims for Long Term Disability and Short Term Disability.  If your claim is denied, the plan administrator (often the insurance company that insures the benefit plan) must send you a notice, either in writing or electronically, that includes:

  • A detailed explanation of why your claim was denied. The notice must explain why the plan-insurance company disagreed with the views of a medical professional or vocational expert (including those who treated you and those whose advice was obtained by the plan), or the decision of the US Social Security Administration.
  • Identification of the specific plan provisions the denial is based on, including the rules, guidelines, protocols, standards, or other criteria relied upon in denying the claim.
  • Notice that you are entitled to receive copies of all documents relevant to your claim for benefits, upon request and at no cost to you.
  • A description of the plan’s appeal process, including deadlines for filing an appeal, and a statement of your right to pursue your claim in court if your claim is denied on appeal.

If the denial letter does not include all of this information, your deadline to request a review may be tolled until the information is provided.

If you have had a claim for Long Term Disability or Short Term Disability denied, it is important to seek help right away from an experienced ERISA lawyer.  ERISA is a complicated statute, and the deadline to act may be very short.  Do not wait to contact us for a free consultation as soon as you receive your denial letter!