Know Your Rights to Short-Term and Long-Term Disability Benefits: Explained by Our Disability Lawyer at Silver & Silver

 The Employee Retirement Income Security Act, more commonly known as ERISA, is one of the most complex bodies of law rivaling even the tax code.  Unfortunately, workers injured in Pennsylvania will have to navigate ERISA to recover short-term or long-term disability benefits.  Often this is an unfair fight, as workers are suffering from physical and emotional injuries while trying to decipher the complex matrix of laws and regulations.  Even minor errors could result in a denial of an otherwise valid claim.  Do not try to do this alone.  Ask for help from an experienced disability lawyer in PA.

At Silver & Silver, we have over 40 years of experience handling disability claims in Pennsylvania.  We were even one of the first law firms in our area to accept cases in this field.  As a result, we have forged relationships and a practical understanding of maximizing the recovery our clients may be entitled to under the law.  Learn more about how we can help you by dialing 610-638-7255.

What is ERISA?

ERISA is extensive with its scope covering health, retirement, and long or short-term disability benefits.  This includes regulating how employer disability plans function, including setting up a claims process and establishing rights for workers if claims are underpaid or denied.  Injured workers can submit a claim on their behalf or are entitled to legal representation through every step of the process.

When Does ERISA Apply?

Generally, ERISA will apply when a worker has an ERISA-governed plan.  An employer usually identifies this at the time of starting employment.  ERISA covers most private companies offering short or long-term disability insurance.

When Does ERISA Not Apply?

There are some exceptions where ERISA may not apply, even to private companies offering ERISA claims.  Some of the most common instances where ERISA does not apply include the following:

• Government workers may not be covered because their agency may already have benefits included with their employment
• Workplace injuries and accidents which workers’ compensation insurance may cover
• Certain plans where participants must pay premiums
• Churches
• Some temporary employment agencies, and
• Other exceptions that could apply.

If you are unsure where you may claim short-term or long-term ERISA benefits, ask a disability attorney like one of ours at Silver & Silver for help.

Steps to Take to Make an ERISA Claim in Pennsylvania

One of the most complicated aspects of ERISA is the variables it allows companies to have in choosing to offer certain health benefits.  This means that benefits could vary from company to company.  Employers could also change plans and options quite frequently.  Most employees have no idea what coverage they have or read the ERISA notices unless they are injured and need to submit a claim.

Some of the most important steps that our disability lawyer wants everyone to know about an ERISA claim include the following:

1) Know Your Plan – almost no two plans are the same.  To submit a claim and maximize your benefits, you need to obtain a copy of your plan and read it thoroughly.  This includes knowing the notice requirements and obligations you have.  You can get your employer’s plan through your boss, manager, or human resources department.

2) Learn the Difference Between Short-term and Long-term Disability – it is important to know the difference between short-term disability and long-term disability, and realize that your plan may only have one or the other—sometimes both, but not always.  The difference in benefits for short-term and long-term could have a significant impact on your claim, and it is imperative that you thoroughly review your financial situation, including your current needs and future needs, in determining how to proceed.

3) Confirm Your Total Coverage Before Filing a Claim – paperwork and benefits are frequently updated, including adjusting upwards.  Before you submit a claim, make sure to confirm your limits and coverage.  You may be entitled to higher coverage than the paperwork you find states, which can help better compensate you.  Get this confirmation in writing to help support your claim.

4) Never Delay Filing a Claim or an Appeal – plans have stringent time limits on when to file a claim after disability onset.  Ensure you comply with any requirements in a plan to ensure you have a full range of your options.  But most importantly, make sure to timely appeal an adverse decision because an untimely appeal will make an unfavorable decision unchallengeable and final.

5) When in Doubt, Ask for a Disability Lawyer’s Help in Pennsylvania – unless you are trained or have experience handling short-term or long-term disability claims, it is often best to ask a disability lawyer for help.  There are many pitfalls and traps in filing an ERISA claim.  Mistakes are often fatal to your application or can guarantee you lower benefits than you may have been able to recover if you correctly filed a claim.  Having an experienced disability attorney and law firm review your plan, financial situation and discuss what options you have can improve your odds of getting benefits and the amount you are entitled to.

Call Silver & Silver’s Disability Lawyers for Help

We know that filing a disability claim can be overwhelming, especially if you are seriously hurt or suffering from a debilitating disease or condition.  Let Silver & Silver handle the legal paperwork while you focus on recovering and being with your family.  We offer FREE consultations, which can be scheduled by dialing 610-638-7255 or by using our “contact us” box available here to send us a message.