Most workers already understand that if they get hurt on the job, they can likely apply for workers’ compensation insurance benefits. Workers’ compensation provides both short-term and long-term disability benefits that injured workers can access depending on certain factors related to their injury or illness, as well as medical coverage without deductibles or co-insurance.
However, there are many limitations to long-term disability benefits through Georgia workers’ compensation. Specifically, the benefits typically only pay a portion of your average weekly wages, up to a state-created cap which is currently $675 per week. For workers already struggling to get by, taking a cut in their weekly income while also struggling with medical bills can be quite problematic.
Many employers choose to close that gap by purchasing private long-term disability insurance for their workers or contributing to the cost of the premium for this important coverage. When you need to claim those benefits, you have certain rights under the law. The Employee Retirement Income Security Act of 1974 (ERISA), in particular, protects your rights to benefits and to fair consideration for your claims.
ERISA compliance requires specific standards and transparency
Employer-sponsored benefits can be difficult to understand, even when the company providing them to workers is nationally known for quality. ERISA specifically creates requirements for who administers or manages a plan and its benefits. Beyond that, ERISA enshrines certain rights for workers.
For example, you have the right to receive a booklet or pamphlet that outlines the specific benefits provided by the policy. You should also receive documentation related to how to successfully file a claim. Plan administrators must make their processes somewhat transparent so that applicants and policyholders know what to do to connect with the benefits they have paid for.
When you do eventually file a claim, ERISA creates a time frame in which the company must respond. They cannot indefinitely delay providing an answer to your claim. In most cases, the insurance provider has 45 days to reach a determination. In cases where they need extra evidence, they can make an extension of up to 30 days to collect evidence and then potentially another 30 days after receiving that evidence.
In the event that you find your claim denied even after waiting and providing medical evidence that you need your benefits, ERISA guidelines also provide the right to file an appeal.
ERISA regulations protect you from unscrupulous companies
Lawmakers initially passed ERISA in part because employers and benefits companies were not fulfilling their obligations to workers who depended on insurance policies or pensions. ERISA helps ensure that companies follow through on what they promise to workers.
Knowing your rights when it comes to an employer-provided long-term disability insurance policy meant to supplement or replace workers’ compensation is critical for anyone dealing with a permanent, debilitating injury.
