Getting Through Your Divorce and on With Your Life

Four Mistakes To Avoid When You File An ERISA Disability Claim

17 March 2016

Celina Henry

Filing a claim for disability benefits is a serious matter. You need to make sure that your employer-provided health plan compensates you fairly so you do not suffer financial hardship or fail to obtain quality medical care when faced with a disability. The process of a filing a claim can be tedious, with unexpected twists and turns. A minor error in your paperwork can lead to a delayed or denied claim.

If you want to ensure that you receive adequate compensation, avoid the following missteps when you need to file for disability benefits.

Underestimate the Complicated Nature of Claims

The federal Employee Retirement Income Security Act, known as ERISA, sets the standards for disability benefits. Initially passed in 1974, several amendments have been added to the law that expand benefits for certain types of claims.

Even if you are very familiar with the fine print of your health plan's benefits, there are many rules in ERISA that you must follow in order to file a successful claim. It is more complicated than filling out a few forms provided by your company's human resources department and insurance provider.

If you need help understanding the process, do not rely on the advice of friends and family who feel they know what you should do because they have filed a claim in the past with success. Even if their medical situation is similar to yours, there are too many factors at play, such as the effect of recent amendments to ERISA, to make an accurate comparison.

Attempt to File a Claim Without Legal Assistance

As soon as you realize that you will be unable to work for an extended period and need to file a disability claim, you need to contact an attorney with expertise in ERISA law.

Moreover, outside of informing your employer that you plan to file a claim, you should not offer any more information to them until you have consulted with a lawyer.

Do not discuss your claim with your human resources department or your company's insurer. Do not take up any offer by the insurance company's claims representatives or lawyers to assist in helping you fill out paperwork. Their objective is to help the insurance company pay out as little as possible.

Your attorney will provide expert assistance to help you fill out your claim application, conduct background research, help you gather necessary documentation such as pertinent medical records and if necessary, negotiate on your behalf with the insurance company responsible for granting your benefits.

If the insurance company acts in bad faith and commits violations, your lawyer can report them to the proper authorities and advocate on your behalf.

You should be wary of the following insurance company tactics:

Delaying payments
Failing to pay out the full value of a claim
Not abiding by the terms of your health coverage plan
Refusing to negotiate

Ignore Medical Directives

It is imperative to follow your doctor's orders, not only to stay healthy, but to avoid putting your disability claim in jeopardy. When an insurance company is determining whether or not to pay out a claim or continue offering you benefits, they will monitor your activity.

You may have to submit an activity log to the insurance company to assure them that you are following your doctor's orders. Some insurance companies will also hire an investigator to conduct a background check and monitor you to make sure you are not filing a fraudulent claim.

Give Up After a Denied Claim

If your initial claim is denied but you are sure that you deserve benefits, do not give up. With the help of a lawyer, you can mount an appeal. Your insurance plan administrator is required to provide you with details on how to submit an appeal.

If you filed your first claim on your own, the reason for your denial could be as simple as not providing enough information to the insurance company.

However, do not wait too long to appeal a denied claim. Per ERISA, you have 60 days to submit your appeal.

Click here to find out more about filing a disability claim.

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Going through a divorce? I know how you might feel – alone, stressed out, and probably even a little sad due to the loss of the life you have always known. Whether you have children or not, you might even feel a little guilty about the break down of your relationship. But I'm here to tell you that a divorce is not the end of the world. In fact, once you get used to the idea and start to move on with your life, you may find just as much, if not more, happiness than you ever had while you were married! Getting through the proceedings of your divorce in a dignified manner is the first step, and hopefully this website will give you the insight, support, and motivation you need to get through the process as painlessly as possible.