Can You Sue for a Short-Term Disability Denial Under ERISA?
You should get what you pay for—especially when it comes to short-term disability coverage. And if an insurer denies your disability claim after you suffer a debilitating injury, you don’t have to accept the first “no.” You can appeal the denial, and you may be able to file a short-term disability denial lawsuit under ERISA.
Before you file a lawsuit, you need to know the steps, the rules, and why having an experienced ERISA attorney makes a difference. At the Peace Law Firm, we have decades of experience helping ERISA plan beneficiaries. We fight hard for our clients and want what’s best for them.
Understanding ERISA and Your Rights
The Employee Retirement Income Security Act of 1974 (ERISA) sets minimum standards for private employer benefit plans, including short-term and long-term disability. If your coverage comes through your job, it’s likely governed by ERISA.
ERISA coverage means your insurer must follow specific rules when reviewing and deciding claims. These include:
- Giving you a full and fair review of your claim,
- Providing detailed reasons for denials, and
- Notifying you about its appeal process and your right to sue.
Unfortunately, many insurers cut corners. They delay decisions. They ignore key medical evidence. They deny claims based on flawed logic or outdated records. If this happens to you, you have multiple opportunities to hold your insurer accountable.
When Can You File a Short-Term Disability Denial Lawsuit?
If your short-term disability plan is insured or otherwise governed by ERISA, which many employer-provided plans are, you may be able to file a lawsuit if your insurer has denied your claim or dragged out the process. However, timing matters. A detailed review of your insurer’s dispute resolution rules is also important.
Generally, you must first exhaust your administrative remedies under your plan before you can file a lawsuit. That means:
- Appealing the denial. Unless your insurer’s rules give more time, you usually have 180 days from the date of denial to file an internal appeal with the insurer.
- Waiting for a decision. The insurer typically must respond within 45 days, but they can have 45 more days to decide if they notify you in writing before their first deadline passes.
The law allows insurers to require two appeals before you sue. If your insurer requires two appeals, the insurer must make both decisions within 45 days.
An insurer must also make appeals decisions that are independent of their denials. This means that an insurer must use a new and independent individual to review your claim. If your insurer denies all required appeals, fails to respond, or does not follow appeal rules established by the plan or law, you can file a lawsuit in court.
Why You Need an Experienced ERISA Attorney
In general, a series of complex federal and state laws govern your rights in a short-term disability claim. Navigating these laws and the rules of your policy is not an easy task. And missing a deadline or submitting the wrong documentation when challenging a denial can sink your case before it starts. That’s where the Peace Law Firm comes in.
For over two decades, we’ve helped individuals in South Carolina fight back after short-term disability denials. We know how insurers operate. We know the court system. And we know how to turn a cold paper record into a compelling story that shows why you deserve your benefits.
We can help do the following:
- Negotiate a fair resolution to your short-term disability dispute,
- Thoroughly review your plan to determine your obligations and the best strategy for challenging a denial,
- Submit your appeal and the appropriate documentation for an appeal review,
- Determine if your insurer properly reviewed your appeal, and
- File a lawsuit against your insurer for an improper denial.
Whether your insurer ignored your appeal, delayed your claim, or denied you unfairly, we can help you take the right next step before it’s too late.
Take Action with the Peace Law Firm Today
A short-term disability denial lawsuit isn’t something you want to handle alone. The clock is ticking, documents matter, and insurers are counting on you to give up. Don’t. Contact the Peace Law Firm for top-rated help with your insurance claim. We are highly experienced, passionate about asserting your rights, and dedicated to representing insured individuals only (NOT insurers).You can call the Peace Law Firm today or contact us online. We can review your case, explain your options, and fight to get you the benefits you’ve earned.
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