Prohibited transactions under the Employee Retirement Income Security Act (ERISA) broadly refer to transactions with potential conflicts of interest.  Understanding what the prohibited transactions are is essential.  Types of prohibited transactions There are two general types of prohibited transactions: Transactions with “parties in interest” involve direct or indirect transactions between the plan and individuals or entities considered “parties in interest.” For example, if a plan fiduciary causes the plan to enter into a transaction with a party in interest, it may be conside ..read more

Insurance companies that issue long-term disability policies governed by the Employee Retirement Income Security Act of 1974 (ERISA) have many responsibilities to policyholders. Insurance company employees generally need to act in the best interests of policyholders due to a fiduciary duty imposed by the law. Businesses also need to allow an appeal if they reject a long-term disability benefits claim and the policyholder disagrees with their decision. Despite those rules, people may still find themselves unable to get the coverage they require when dealing with a disabling medical condition. I ..read more

If you’re looking to make an ERISA disability claim, one of the first steps in the process is simply getting the diagnosis that you are disabled. With many different disability cases, this medical evidence is the crux or the cornerstone for the entire claim. It helps to show exactly why the condition is a disability and how that will affect a person’s life moving forward. But some people will get what is known as a “diagnosis of exclusions.” This can make the process a bit more complex, even if you believe that your medical team has correctly identified the issue. Why is this controversial? Is ..read more

If you are facing a long-term disability claim denial in California, you know how frustrating it is to go through that. However, there is additional knowledge you should have and resources you should consider. First, let’s go over what an appeal is. Simply put, if the insurance company denies your long-term disability claim, you may ask them to take another look at it. You can also have an attorney help you by advocating for you in this process. In California, the number of times you can appeal a denial depends on the insurance policy. Though, there are certain steps laid out for people who ap ..read more

If you develop a physical or mental illness/ injury that prevents you from performing your job duties, you may be eligible for disability benefits. You can receive a percentage of your income for a particular period, allowing you to recover comfortably. However, your claim may be denied, which can be devastating. If this happens to you, consider doing this: Find out why your claim was denied If your claim is denied, stay calm and find out the reason behind it. Do not panic, as this may lead to costly mistakes. Carefully read the denial letter to determine how you can resolve it. According to t ..read more

One type of disability that affects the hands is ulnar nerve palsy. This is nerve damage that causes someone to involuntarily bend or curve their fingers. These hooked fingers remind people of a claw, so this disorder is sometimes referred to as “claw hand.” In some cases, people are born with this disorder. Others suffer nerve damage due to an injury or in some other way, and they develop the claw hand disorder over time. It can also be more severe in one patient than it would be in another, so the experience may be different from one case to the next. What are some potential causes? One pote ..read more

Workers in private industries benefit from the protections of the Employee Retirement Income Security Act (ERISA). This federal law sets specific standards for various aspects of health plans and pension plans. When it comes to long-term disability (LTD) benefits, ERISA governs the appeal process for denied claims. If an LTD claim is denied, the plan must provide a written explanation of the denial, referencing the specific plan rules on which the decision was based. This notification also outlines the process for filing an appeal and provides important information about the process. Comprehen ..read more

The Employee Retirement Income Security Act of 1974 (ERISA) governs more than just employer-sponsored retirement benefits. The law also applies to other key forms of benefits provided by businesses for employees. If a worker’s employment benefits package includes private disability coverage, ERISA rules may also apply to those benefits. ERISA requires that the insurance professionals handling claims look at the needs of the policyholder before considering the financial priorities of the business. The law also entitles an applicant to an appeal if the insurance company reaches an unfavorable de ..read more

Accidental Death and Disability (AD&D) insurance provides beneficiaries with a financial safety net in the tragic event of a policyholder’s accidental death or loss of a specific body part. If your employer provided these benefits, the Federal Employee Retirement Income Security Act (ERISA) likely applies. Although there are many layers of protection, not all claims are straightforward, and denials can occur for various reasons. You do not have to accept a denial: Basics of the appeals process When an insurer denies an AD&D claim, beneficiaries have the right to appeal the decision. An ..read more

Someone who has filed a claim for long-term disability insurance likely expects a simple claims process. However, sometimes people who cannot work because of medical issues have a hard time getting the benefits they need. Even when someone has disability coverage provided through an employer, they may not receive approval when they initially claim benefits. Thankfully, disability insurance coverage provided as part of an employment package is subject to rules established in the Employee Retirement Income Security Act of 19874 (ERISA). One of the most important ERISA protections for those denie ..read more