Decoding Erisa Disability Benefits

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DECODING ERISA DISABILITY BENEFITS
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Long-term Disability and ERISA
People who have a long-term disability (LTD)
insurance policy, and are unable to work could be
eligible for long-term disability benefits.

• The Employee Retirement Income Security Act
  (ERISA) is
• a federal law that governs most group LTD
  policies
• ERISA created a uniform system of taxation and
  one body
• of law to throw light on the intricacies of
  employee benefits
• ERISA is applicable only to disability insurance
  benefits offered
• by an employer as part of an employee
  benefits package

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ERISA Disability Claims Process

• Medical records review is performed to identify
  the primary
• and secondary causes of medical disability
• Claimant should list all medical conditions
• Claimant should be able to clearly articulate the
  medical
• condition(s) that primarily causes the
  inability to work on a
• full time or part-time basis

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Long-term Disability Benefits - Important
Considerations
The necessary requirements disabled individuals
must meet to qualify for long-term disability
benefits under an employee-sponsored ERISA plan
are

• A minimum length of service
• A minimum waiting period before the benefits
  start
• Qualifies under the plans definition of total
  disability

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Filing of Long-term Disability Claims -- Dates
and Deadlines

• A claim is approved or denied within 45 days of
  receiving it.
• The particular plan may extend the 45-day time
  frame by up to 30
• days. In this case, the insurer must inform
  the insured of its request
• for an extension within the first 45-day
  period. The insurer should
• explain why they need additional time, what
  additional time or
• info is necessary , whether there are
  unresolved matters, and when
• a final decision will be made.

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• The insured person has 45 days to respond if the
  insurer makes a
• request for additional information.
• Once the insured provides the requested
  information, the claim
• would be decided within 30 days or as
  required by the plan,
• whichever comes first.

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Appeal Process in Case of Claim Denial

• The applicant has a period of 180 days following
  the receipt of a
• denial notification to file an appeal.
• An appeal must be decided within 45 days of
  receipt by the insurer.
• Sometimes review of the appeal request may
  require additional time
• especially in special cases. The insurance
  plan can request up to an
• extra 45 days, providing an explanation of
  the circumstances and an
• expected date when the decision will be
  given.

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Medical record retrieval and medical records
review have great significance in relation to
ERISA and disability claim lawsuits. Therefore,
providing all support information including
medical reports from doctors, letters from
employers and so on during the administrative
appeal in very important.
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Contact us at for all your medical record and
medical chart review  requirements
Headquarters 8596 E. 101st Street, Suite
HTulsa, OK 74133
Main [phone]Fax (877)
835-5442E-mail info_at_managedoutsource.com
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