ERISA Compliance in Florida | The Law Office of Nancy L. Cavey

Working Diligently to Secure the Long-Term Disability Benefits Our Clients Deserve

The Employment Retirement Income Security Act (ERISA) is an important law that sought to prevent abuse against American workers. While its primary goal was to create minimum standards for employee pension plans, it also plays a significant role in long-term disability (LTD) claims. If you’re having trouble securing benefits through your employer’s LTD provider, understanding ERISA compliance in Florida is absolutely essential.

At The Law Office of Nancy L. Cavey, we consistently see good people face unfair burdens after being wrongfully denied long-term disability benefits. If you secured coverage through your employer, then the plan falls under ERISA and must remain compliant. Even if you purchased your own LTD policy from a private insurance company, there are still state laws in effect to protect you and ensure you’re getting the benefits you deserve.

Don’t risk your financial security by taking on insurance companies alone. Contact our Florida ERISA attorneys today for a free consultation.

How Does Florida ERISA Compliance Work?

ERISA sets standards that most private-sector employee benefit plans have to abide by. This includes employer-sponsored long-term disability plans. For Florida companies to remain compliant with the law, they must follow established rules for disclosure, reporting, fiduciary responsibilities, and claims procedures.

While many people have plans from insurance companies through their employers, there are also many who have self-funded plans. ERISA compliance is required for each of these plan types. When someone suffers a serious injury or medical condition, the main issues of ERISA compliance in Florida relate to the claims procedure.

ERISA has specific requirements that LTD plans must follow with claims procedures. These requirements include giving written notice of benefit determinations, disclosing all reasons for benefit denials, and giving policyholders the ability to file an appeal for denied claims. Unfortunately, they don’t always make the process easy — but a lawyer may be able to help.

What if Your Long-Term Disability Plan Isn’t Covered By ERISA?

If you’re concerned that your LTD policy may not have ERISA protection, it’s important not to panic — even if your claim has already been denied. Many people are covered by ERISA even without realizing it. That’s because the majority of benefit plans provided to private-sector employees are covered. This means plan administrators must follow federal rules in most instances. It also means you likely have more rights than you realize.

However, it’s true that not all long-term disability plans will fall under this law. Does this mean that your LTD plan doesn’t have to meet ERISA compliance in Florida? The answer to this question is yes and no. Even if your plan isn’t required to meet federal statutory requirements, there are typically similar state laws that provide similar protections. Therefore, you should never simply accept a benefits denial if you have paid into an LTD plan.

How Does ERISA Apply to Long-Term Disability Claim Denials?

ERISA plays a role in nearly every aspect of long-term disability claims. For instance, plans are required to provide benefit determinations within 45 days of receiving a person’s claim. Extensions are allowed in some instances, but even these must be explained to the claimant. If the plan determines that a person isn’t eligible for LTD benefits, they have to disclose why.

Afterward, claimants are allowed a full and fair opportunity to appeal. This includes the right to review evidence considered by the plan, respond to evidence when appropriate, and even offer additional proof for their claim during the process. ERISA also requires that appeal reviewers not have been involved in the original denial.

So, what happens when all administrative appeals are exhausted? Federal law allows claimants to file an ERISA lawsuit in federal court. Clearly, an LTD claim denial is not the end of the road — even if a plan ignores the requirements of ERISA compliance in Florida. Of course, navigating these rights can be a difficult task. Contact our long-term disability attorneys for assistance.

What if You Don’t Qualify for Long-Term Disability Benefits?

If you qualify for long-term disability benefits, ERISA can help ensure you get everything you deserve. Unfortunately, LTD plans sometimes deny claimants because they’re truly ineligible for benefits. If this is the case, it can be difficult to figure out how to move forward. Our ERISA compliance attorneys have seen many people deal with such challenges.

However, being ineligible for long-term disability does not mean you have no options. For instance, those who suffered an injury during the course of employment may qualify for workers’ compensation benefits. It’s also the case that — if your injury or condition will not last longer than a year — you may qualify for short-term disability in Florida. Of course, there are other options that have nothing to do with your employment or benefits provided by your employer.

For instance, many people who suffer injuries that will keep them from working are able to apply for Social Security Disability (SSD) benefits successfully. Supplemental Security Income (SSI) could also be available for individuals who are low-income and meet other eligibility requirements. The simple fact is that there are often a variety of options available when you can’t work — and many have nothing to do with ERISA compliance in Florida.

Contact Our Florida ERISA Compliance Lawyers Today

Suffering a serious injury or debilitating medical condition can change everything. Even when such issues aren’t permanent, a person’s life can be turned upside down if they’re unable to work for a prolonged period of time. Long-term disability insurance is meant to offer peace of mind in these situations, but far too often, it only leads to additional headaches and uncertainty. Fortunately, you don’t have to go through this alone.

At The Law Office of Nancy L. Cavey, our legal team knows what it’s like to worry about where your next check is coming from. Many of our staff witnessed their parents deal with the difficulties of seeking disability benefits. This is why we’ll never rest when we see insurers wrongfully deny coverage to people who deserve it. Our attorneys can help you understand ERISA compliance in Florida and how to best move forward.