Bridgeport ERISA Disability Claim Denial

Filing for long-term disability insurance could be a complicated process that requires you to navigate all the rules and deadlines with limited assistance from employers. Once an insurance company denies a claim, you could be wondering what your next option is.

If you have experienced an ERISA disability claim denial, consider hiring an experienced Bridgeport lawyer to help understand why your application was rejected. Attorneys familiar with ERISA law could navigate the obstacles disability benefit applicants face. Legal counsel could assist you in getting the claim process back on track.

ERISA Disability Benefit Claims

Getting a claim filing right the first time can be difficult. Bridgeport employees should become familiar with the policy’s scope, exclusions and limitations, and what paperwork they will need to submit in support of their claim.

Common Reasons for Claim Denial

Reasons for claim denial vary greatly. It is insurance companies’ job to review and process claims, and they can be sticklers to the rules. The smallest infraction can result in a claim rejection. The following list is some of the most common reasons for claim denials.

  • Inadequate medical evidence of disability
  • Conflicting medical opinion on the part of the insurance company doctor
  • Pre-existing medical conditions
  • Failing to meet the definition of disabled
  • Untimely filing
  • Policy exclusions
  • Incomplete or erroneous information on the claim form
  • Contrary evidence uncovered by the insurance company

In many instances, claimants can rectify defects in the initial claim filing through appeal. Claimants should be aware that insurance companies could investigate the claim themselves. If the company finds evidence contradicting the claimant’s physical abilities through the investigation, it could be a significant setback for proving the necessity of disability benefits.

Bridgeport attorneys understand that ERISA disability claim denials have immediate and severe implications for sick or injured employees. A lawyer could assist with denied claims to help the individuals understand the problems and plan for success on appeal as swiftly as possible.

Contents of a Disability Insurance Claim Denial

Once the employee has filed a claim, ERISA sets a 45-day time limit within which it must provide notice of approval or denial of the request. However, insurance companies may, under certain circumstances, extend this review period up to 30 days.

If the insurance company issues a denial, it must provide a written hard copy or electronic explanation. By law, the notification must also include the following:

  • A detailed explanation of the denial, including why the insurer disagreed with medical determinations in the employee’s claim
  • Which plan provision, rules, or guidelines form the basis for the rejection
  • Notification that the claimant is entitled to access or receive copies of all relevant claim materials upon request and at no cost
  • Description of the appeal process

The Appeal Process

ERISA provides that claimants have a minimum specified period to file an appeal. The notification of denial should inform clients how long they have.

A different claim reviewer within the insurance company, who was not involved in the initial claim denial, is responsible for reviewing an employee’s appeal anew.

Once submitted, the insurer’s timeframe to review an appeal is 45 days from the filing date, except in the case of an extension. Policies could have one or two internal levels of appeal before the claimant has exhausted administrative remedies.

Assistance with a Bridgeport ERISA Disability Claim Denial from an Attorney

ERISA disability claim submissions can be complicated at multiple stages of the process. A claim denial can be frustrating because the insurance company may cite various flaws in the filing that seem hard to overcome.

It could be beneficial to consult a lawyer to help you make sense of a claim denial. An attorney could aid your claim resubmission to avoid further appeals or a lawsuit. If your ERISA disability claim was denied, contact a Bridgeport attorney today to learn more about your options.