Lisa S. Kantor, leading expert on eating disorders and disability law, discusses how to deal with ERISA when it comes to eating disorders.
2015 marks 41 years since ERISA was signed into law and it still creates a tangled web for those with mental and physical disabilities. Kantor offers tips for those who have been denied disability insurance claims.
The Employee Retirement Income Security Act (ERISA) is a complex statute that regulates employee benefits such as pensions, life, health, and disability insurance plans.
Policyholders can find it challenging not only to file a claim but also to learn about the process to handle denied claims with these insurance policies. The steps to appeal a denied claim are similar for the various types of insurance.
It is particularly important to gather any and all relevant and send copies to the insurance company:
"The reason it is especially important to 'get it right' is that under ERISA, if your denial is upheld on appeal and you still disagree with the decision, the administrative record/claim file is 'closed' and you are not allowed to submit new information except in rare circumstances. Consequently, any Court that reviews the claim decision will typically be limited only to the claim file in front of the appeals examiner," (Disability Insurance Claims: Massachusetts CFIDS/ME & FM Association, January 13, 2015).
Employers do not necessarily have to participate in offering benefit plans to their employees but if they do, they must meet the minimum requirements stated in the ERISA statute and regulations.
As many policyholders know, a denied claim can be stressful and countless people don't know what procedure to follow to appeal. For health issues, such as eating disorders, most insurance companies will not see certain treatments as medically necessary, therefore denying any claims they receive. Read More
When policyholders know the appeals process with the insurance company and with ERISA, they will have a much better chance of a positive outcome. Thankfully, there are many talented individuals out there who are able to advise patients and families about the rules to follow in order to get the coverage they rightfully deserve.
"The insurance company is going to do whatever they can to keep you from following through on a denied claim," states Lisa S. Kantor, founding partner of Kantor & Kantor, LLP and leading expert in eating disorder claims
"They will place obstacles in your way like deliberately misinterpreting your requests for your insurance documents. Their hope is to mislead and confuse you so that you will not continue your quest to appeal the denied claim. I encourage you to find a lawyer who is knowledgeable in both ERISA and eating disorders for help in managing this overwhelming process. There are people out there who want to help so don't lose hope!"
ERISA is a complicated topic with many gray areas.
Policyholders shouldn't have to fight this battle on their own.
With complicated health issues pertaining to eating disorders, the conflict is doubly tough, leaving many sick with no way to pay for treatment.
Individuals and their families are urged to get in touch with an experienced lawyer today so that they can begin looking to a happier future.