The plan administrator makes decisions on whether to approve or deny your claim for LTD benefits. Some insurance companies have their own claims departments that act as the plan administrator. Other insurance companies delegate the processing of claims to a third-party plan administrator. When companies are self-insured, they also may use a third-party plan administrator to facilitate claims. In some cases, your employer even may act as the plan administrator.

When you apply for LTD benefits, you submit a claim to the plan administrator for processing. The plan administrator will ask your doctor to fill out a form regarding your diagnosis and medical conditions. However, the plan administrator is likely to ask for you to sign a release form to allow him or her access to your medical records. This allows the plan administrator to consider not only your doctor’s opinion but also any objective evidence of your disability, such as lab test results.

If ERISA governs your LTD plan, which is the case with most employer-sponsored LTD plans, the plan administrator also must follow all rules and guidelines mandated by ERISA. ERISA or the Employee Retirement Income Security Act establishes specific timeframes and deadlines that plan administrators must follow in processing claims. For instance, ERISA determines how long a plan administrator has to respond to an initial claim for benefits and when and how frequently an administrator can obtain an extension of time to respond. ERISA also requires that notices that a plan administrator issues to claimants contain specific information about their rights to appeal and other vital issues.

ERISA also requires your plan administrator to provide you with a copy of your employer’s disability plan at no cost to you. Employers routinely provide employees with summary plan descriptions, which are much shorter than the actual plans. As a result, if you want to review the entire plan, you likely will have to ask for a copy of it.

Long-term disability claims are complex matters that require intensive knowledge of ERISA laws and regulations. As a result, you will need experienced legal representation and advice to pursue an ERISA-governed disability claim. Bonnici Law Group is a law firm focusing on ERISA long-term disability benefits and bicycle injury cases in San Diego, CA. When you need effective legal representation, contact Bonnici Law Group at 858-261-5454 or email us at help@bonnicilawgroup.com.