When my husband I decided to start a business, we didn't think about the legal aspects of doing so. We didn't realize that purchasing business insurance, getting building permits and making investments all required some type of legal advice. But after speaking to a close friend, who also happens to own a small business, we contacted a business attorney. Now, we have the legal smarts to make the best decisions for our business, as well as the legal representation in case something happens to our company. I hope that you find my blog helpful and informative for your own business. It's a great resource for finding the legal advice, resources and guidance you need to get your company up and running.
While you are entitled to disability benefits under federal law if you are a full-time employee in the private sector, the process of filing a claim to receive compensation for medical treatment can be a long, drawn out and complicated process. And even after you file a claim, you may not receive the benefits you deserve. If your claim is denied, you need to know your rights in order to launch a successful appeal. The following guide provides you with a primer on what you need to know when you file an appeal or want to sue.
Request for Documents
The Employee Retirement Income Security Act of 1974 (ERISA) governs the terms of disability claims and appeals. Per this legislation, if you are denied a claim, you will receive an official letter detailing why your application was unsuccessful. However, you have the right to request documents related to your case from the disability insurance company at no charge.
If you did not seek legal counsel to help file your initial claim, hire an attorney as soon as possible to help you request these forms from your company's disability insurance provider.
Appeal Time Limits
When you need to file an appeal, you have 180 days to resubmit your claim. You should begin working on your appeal as soon as possible with the help of an attorney so you have time to gather additional records to support your case, track down any missing documents, undergo additional medical tests and request statements from doctors.
If you fail to file a proper appeal and your submission is denied because of errors on your part, you will not be able to sue your employer in court for the disability benefits you deserve.
The Right to Sue
If you feel that your employer's insurer failed to follow correct procedures or did not fulfill their federal obligation, you can sue for remuneration. In some instances, your appeal may denied because an insurance company and your attorney disagree on what types of treatment can be reimbursed or what kinds of future medical treatment you can seek for your health problems.
In addition, insurance companies must follow time limits when deciding on the outcome of a claim. If you fail to receive a decision in a timely manner, you may have grounds for a lawsuit.
The time frame for a decision depends on the type of claim you file. For example, the time limit for an urgent care claim will differ from a claim that seeks reimbursement for medical costs already provided.
Insurance companies can also extend the time limit if they determine that your case includes special circumstances that require additional review. However, they must inform you in writing that an extension is needed.
Federal Court Cases
Because disability benefits are under the jurisdiction of ERISA laws, you must file your appeal in a federal court. Therefore, it is important that the attorney you hire has experience in handling federal disability cases. This is crucial because, even though ERISA is a federal statute, opinions handed down by federal courts can affect the interpretation of rules, including things like the validity of filing deadlines that fall on weekends.
Even with the help of an attorney, it may be difficult for you keep all of the details about your disability case straight. Accordingly, you should keep a written journal for yourself to help you keep an accurate record of the ordeal. The journal will be helpful for you to review the chain of events in case you need to testify in court when you sue.
For more information, contact an experienced lawyer who is familiar with ERISA disability claims.