Long Term Disability Claims (LTD Claims)
If you obtained your disability insurance through your work, and you work for a private business, your disability claim is probably going to be subject to a federal law called ERISA. ERISA stands for Employee Retirement Income Security Act. It governs not only private employee pensions, but almost all other employee benefits afforded in private employment.
ERISA changes the way disability claims are handled legally. Such changes include:
- a requirement that the claimant exhaust administrative remedies, with specific time limits for "appealing" the initial denial of his claim;
- an administrative record which is controlled by the insurance company or other claims fiduciary;
- a requirement that the evidence be in the administrative record before the court will even consider it; and
- a standard of "arbitrary and capricious" review. Where the "arbitrary and capricious" standard applies, the courts often will not reverse the insurance company unless the denial decision is completely unsupported in the record.
Long Term Disability claims are a mine field for the unwary claimant. Do not wait until your appeal has been denied to obtain counsel experienced in ERISA and disability claims subject to ERISA. Get expert help before your appeal is blown (determined by the self interested carrier without the necessary documents which support your claim). If you are expecting the carrier to load the administrative record with material helpful to you, you are making a serious mistake.
For more material on how ERISA affects your LTD claim, read "Basic Information Regarding Long Term Disability Benefits Subject to ERISA".