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Read the fine print even after an ERISA disability appeal victory

Thursday, January 4th, 2018

If a disability insurance policyholder is denied a claim for benefits, he or she has the right to appeal the denial per the Employee Retirement Income Security Act of 1974 (ERISA). While the appeals process can be complex, often necessitating the assistance of an attorney, it is possible to prevail on an appeal of a denied claim. However, such success may be short-lived for some, particularly when it comes to long-term disability insurance.

Once a person is granted disability benefits via an appeal or lawsuit, they may think they are set for life. However, this is not always true. It is important for the person to read the fine print on their disability insurance policies. This is because under many policies, after a person is granted long-term disability benefits for two years straight, their insurer may once again deny their claim for benefits citing a “change in policy.”

What this means that, in an initial claim for long-term disability benefits in general the person must be able to prove they are unable to perform the duties associated with their particular occupation. However, once two years have gone by, many policies are changed so that the person must now demonstrate that they cannot perform any job whatsoever if they want their long-term disability payouts to continue. This is a very high standard to meet, and could ultimately lead to another denial that must once again be addressed through an ERISA appeal or lawsuit.

That being said, those who have been denied disability insurance benefits should not lose hope. It is possible to fight a denial through an ERISA appeal or lawsuit and win. An attorney can assist workers in these endeavors, even if it means they must go through the process more than once.

Source: FindLaw, “Disability Insurers and the Claim Process,” accessed Dec. 30, 2017

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