Generally speaking, a group policy that is provided to you by an employer will be covered under the "ERISA," or the Employee Retirement Income Security Act of 1974. This is a federal law that sets out the standard for how a claim may be administered, such as deadlines for both employees and insurance carriers in regards to filing, responding to claims or appealing their outcomes, and more. The original purpose of ERISA was to protect the rights and needs of workers, but in practice many workers find that their employers and insurance companies have the edge in being able to work around the facts and laws in place. By bringing in our Miami disability lawyers, you are able to even those odds.
Carriers dedicate an enormous amount of time and resources to build a case for their denial of your claim for benefits which includes conducting surveillance and demand an independent medical evaluation (IME) or functional capacity evaluation (FCE),which they either may not have a right to conduct or if they do, they are may be conducting it in an manner inconsistent with their rights under the terms of the policy. For example, the carrier may schedule the evaluation to be conducted in another state or city, by someone other than a medical doctor or even an uninsured provider.
The filing of an insurance claim may appear to be an easy task; however, the insurance carriers’ forms are designed to ask general and vague questions which then allow the carrier to unduly delay your claim under the disguise that they need additional information and documentation.
How to Handle a Claim Denial
You should know that most disability income insurance claims are denied. Under ERISA you have 180 days to appeal a denial of benefits which begins to run as of the date you receive the denial letter. It is extremely important that you know your responsibilities as well as the carriers obligations and timely act through the claims process in order to protect your rights. You have an obligation to appeal the carrier’s denial of your claim in a timely manner.
Unfortunately, it is not an even playing field; the law favors the employer and carrier and as such, you must be aware of your rights and responsibilities under ERISA and under the terms of your disability income insurance policy. Know and defend your rights by seeking a lawyer with experience in dealing with ERISA and the insurance carriers.
Our Miami disability attorneys can be reached at 305.570.4711. Call today to get started!