Anyone can get injured at work no matter the type of job you have and depending on the type of job you have getting injured at work can be a common. Most work related injuries are minor requiring a short amount of time away and the employee returning back at full strength. But some injuries are bad or even catastrophic requiring long term or even permanent care for an employee.
Employers are required to have insurance coverage for their employees in the event of injures requiring long term care. These policies are separate and different from those for injury insurance for minor injuries that only require a short recovery time. Each US employer must cover their employees with a policy to cover their medical, salaries and other costs related to their being unable to work or in some cases function normally while they are injured.
As one would guess, the process for securing a claim against an insurer in these cases requires a long process that includes medical visits, lots of paperwork, lots of pushing and complaining about their responses and response times, and a healthy amount of anxiety and frustration. In short insurers are always reluctant to pay when there is a claim and never make it easy even for those who have never missed a premium payment.
ERISA Governs the Process
The Employer Retirement Income Security Act or ERISA is the federal laws that govern how insurance companies handle disability claims. It lays out the process that each insurer must go through with your company, your doctors and with you to determine eligibility.
Because the insurer is picky about what they will pay for, they will often seek to reject a claim. The process in many people opinions is backwards, because in most ERISA governed claims, an insurer can deny virtually any claim and the person seeking benefits must show that the denial is arbitrary and capricious. This means that a claimant must meet the highest burden of proof in a civil court in order to get benefits. Insurers have used this process as a way to sidestep paying claims or to pay less than needed by the claimant. This of course is to the detriment of those injured at work.
Filing an Appeal
If your claim for insurance coverage is denied in your work injury case, ERISA rules allow you 180 days to file for an appeal. Under ERISA statutes, once your appeal letter is submitted, the long term disability carrier has 90 days to review the materials you have submitted, and decide whether it’s going to overturn or uphold the denial.
Why You Need an ERISA Attorney for Your Appeal
If you are denied benefits in an appeal, there is a short window of time between your being denied benefits and when you can file a lawsuit against the insurance carrier. Additionally, only information submitted by you during the appeal process can actually be included in your lawsuit. So you need the assistance a top ERISA lawyer in your local area. For instance if you live or work in St. Petersburg Florida, you need a skilled and reputable ERISA disability lawyer in St. Petersburg to help.
A qualified and skilled ERISA attorney will prepare your appeal and make sure that you are best positioned for a lawsuit against the insurance carrier in the event you are denied benefits through an appeal. In fact, if an insurer sees that you are working with a reputable ERISA attorney during the appeal, they may be less likely to fight your benefits claim. So bring an attorney on to your case for the appeal can save you time, money and headaches.
Filing and receiving claims for long term care due to a work injury is complicated and difficult. If you are initially denied benefits, hiring an attorney who has the experience to deal with large insurers is the smartest way to approach this process.