There is a lot of unfairness for claimants and participants with ERISA. ERISA may apply to long-term disability, short-term disability, life insurance, pension and retirement benefits.
There are a lot of bad things about ERISA, but there are also good things about ERISA that if used to your advantage can drastically and positively impact your claim.
Last week, we talked about how your ability to obtain your claim record was a good thing about ERISA. The second good thing about ERISA is obtaining your plan documents.
As a claimant, you have the right to obtain your plan documents. Your request for the plan documents needs to be specifically addressed in writing to the plan administrator, and you should ask the administrator for all plan documents relevant to your claim. Sometimes there's more than one, so make sure you ask for all of them.
Within 30 days after their receipt of that request, they are supposed to produce those plan documents to you. Sometimes, there may be an insurance policy and some sort of guideline or protocol that they're using to interpret that insurance policy to determine whether or not you're really disabled.
For example, they may be looking at some sort of guideline such as a medical disability advisor that tells how long you should be out of work after rotator cuff surgery. That guideline may or may not be true because not everyone is exactly the same in their recovery process. In fact, some people never do recover to the extent that they can use their shoulder again after rotator cuff surgery.
Although the plan documents relied upon to deny your claim may not be correct, it's helpful to know what they're using to make their determination.
If you need assistance after your long-term disability claim has been denied, contact an experienced ERISA disability lawyer or long-term disability lawyer today at 800-284-9309.