The ERISA law protects the rights of employees to receive benefits that cover their health. Employers are required to set up insurance policies for employees that will cover their expenses should they become disabled and unable to work again. While many employers these days have this kind of insurance policy for their employees, it’s been discovered that many workers end up not receiving these benefits. This is not the fault of the company and its management, but the workers themselves.
When a disability occurs, the employee is expected to file an ERISA disability claim. It is this application that will determine whether they receive their benefits from the insurance company the employer chose to work with or not. During the process of this application, many workers make certain mistakes that reduce their chances of a favorable outcome.
Many people make these mistakes because they refuse to hire an ERISA insurance claim lawyer to help them throughout the process. This is the first mistake you need to avoid. In this article, we’ll talk about this mistake and four others that you should avoid.
Not Hiring an ERISA Lawyer
As far as an ERISA disability claim is concerned, the process can be quite complex. It becomes even more confusing if the insurance company denies your claim and you have to appeal. Therefore, we advise that you hire an ERISA disability claim lawyer to help you navigate the complexities of the process.
Inaccurate or Incomplete Application
When the information you provide during the application is inaccurate, whether unintentionally or intentionally, it might be flagged when the application is reviewed. This might affect your chances of a favorable result.
Incomplete applications are when you don’t provide adequate information or fail to fill out certain sections. The plan administrator or insurer can misinterpret or misunderstand this. You can check out this post to discover who an insurer is and what their roles are. The outcome might be a denial of your claim.
Failing to Meet Deadlines
There are deadlines you must meet for filing the claim, submitting an appeal if the claim is denied, and providing further documentation. If you miss any of the deadlines, it can lead to your claim being automatically denied and even the loss of your appeal rights. Therefore, you must ensure that you don’t miss any deadlines.
Little or No Medical Evidence
The foundation of your disability claim is medical evidence. If you fail to provide sufficient medical documentation that supports your disability, proving your claim and convincing the plan administrator or insurer can be difficult. Therefore, you should get detailed medical records from all the healthcare providers who took care of you at some point after the incident that caused the disability. Your current healthcare provider should also provide you with a medical report.
The records must contain the following information:
- Diagnosis
- Ongoing symptoms
- Treatment history
- Functional limitations, etc.
Not Following up on the Process
One big mistake people make is that after filing the claim, they just sit and wait for their benefits to come just like that. While that’s the ideal way, it doesn’t work that way most of the time. There is a follow-up that involves the provision of requested additional documentation or information, such as a medical report.
When the insurer makes such a request, you need to follow up on it to prevent delay or outright denial. All correspondence, including phone calls, emails, and letters between you and the insurer, should be presented for future reference. If the insurer doesn’t reply within the agreed timeframe, ensure that you follow them up by reaching out to them.