ERISA, or the Employee Retirement Income Security Act of 1974, lays out employees’ rights and employers’ obligations under retirement and disability plans. That is, when a company or agency offers a pension, 401(k), or similar plan, it must comply with ERISA. The Ohio long-term disability attorneys with Agee Clymer Mitchell & Portman most often encounter ERISA when a client has been denied disability benefits from his or her employer-sponsored retirement plan.
Reversing a disability benefits denial from an ERISA-regulated plan is difficult. A much better course of action for an employee who becomes to injured or ill to work is to partner with a disability lawyer while preparing the original application. Rules written to implement ERISA require disability benefits applicants to submit the following:
While ERISA compels an employer to inform a disabled employee about his or rights to request disability benefits, the process for applying, and the information to include when submitting an application, the guidance is often confusing and incomplete. Consulting with an experienced and knowledgeable attorney who is dedicated only to securing benefits for his or her client will keep a disabled person from preparing and sending in a weak application.
Two of the biggest mistakes an employee can make when dealing with an ERISA-regulated retirement and disability plan are to use only the forms supplied by the employer’s benefits provider and to seek advice only from their employer’s human resources department. Neither the insurance company nor the HR staff want a disability application to fail. Rather, each group has responsibilities to make qualifying for benefits difficult by enforcing arcane policies and looking for gaps in applications that can be as minor as missing signatures and dates. Overcoming bureaucratic hurdles and clearing technical tripwires will be easier with the advice and representation of a dedicated disability lawyer.
Should an application get denied, the disabled employee has the right to request an appeal hearing before a judge. The judge is bound by ERISA to consider only the information submitted as part of the original application and rule whether the insurance company acted improperly in deciding to deny benefits. The desired legal ruling for the disabled employee is “abuse of discretion,” and the decision standard the judge applies comes down to “would a person presented with the information in the applicant’s file deny disability benefits while following all the criteria used by the retirement plan?” Materials in the file can be further explained and placed in context, but new evidence for a disabling condition and/or benefits eligibility cannot be introduced during an appeal hearing held under ERISA rules.
You can learn more about applying to ERISA-regulated retirement and disability plans by requesting a free consultation with an Ohio long-term disability attorney at the Columbus offices of Agee Clymer Mitchell & Portman. Just call (614) 678-3318 or connect with us online. If health problems make travel difficult, we can come to you.