You’ve worked hard, followed the rules, and expected the benefits you were promised to be there when you needed them. But then comes the denial. A letter arrives—filled with technical jargon—and suddenly, the support you’ve been counting on is out of reach. It’s not just frustrating; it feels unfair.
ERISA, the federal law that’s supposed to protect employees’ benefits, was created to prevent exactly this kind of scenario. Yet denials still happen, and they happen more often than they should. The good news? You’re not powerless. When a denial lands in your lap, you have options.
Common Reasons Benefits Are Denied
Benefits denials are not always a reflection of your situation or your efforts. Often, the issue lies with how claims are reviewed—or what’s left out of your application. Here are some common reasons these denials occur:
- Missing Evidence
Insurance companies have strict definitions of what qualifies for a benefit, especially when it comes to health or disability claims. If your medical records don’t check all their boxes, your claim can be denied—even if your condition is real and serious. It’s not about what you know; it’s about what’s documented.
- Plan Rules and Exclusions
Some claims are shut down because of the fine print. Maybe a pre-existing condition is excluded, or the plan has rules about how long you need to work before becoming eligible. These technicalities can be a roadblock to benefits, even for long-time employees.
- Administrative Mistakes
Lost forms, missed deadlines, or improperly filed paperwork can derail a claim before it’s fairly considered. These errors might feel minor, but for insurers, they’re often reason enough to say no.
- Misinterpretation or Mismanagement
Sometimes, the denial isn’t about you at all—it’s about how the plan administrator interprets the rules. Mistakes, biases, or even bad faith decisions can unfairly shut down claims that deserve approval.
Taking Action After a Denial
When your claim is denied, don’t let the rejection be the final word. ERISA gives you a path to fight back, but timing and strategy are critical.
- Read the Denial Letter
That letter you receive explains why your claim was denied and lays out your appeal rights. This is your starting point. Study it closely to figure out exactly what’s missing or disputed.
- Gather and Strengthen Your Evidence
Now’s the time to fill in the gaps. If the insurer claimed insufficient medical evidence, work with your doctor to provide detailed records that match the plan’s criteria. If paperwork was incomplete, make sure every form is filled out and submitted correctly.
- File Your Appeal on Time
Deadlines for appeals can range from 60 to 180 days, depending on the plan. Missing these windows can close the door on your claim entirely, so act quickly. Appeals are your chance to present new information and demand a fresh review.
- Be Persistent
It’s easy to feel discouraged, but the appeals process exists for a reason. Many claims are denied the first time but succeed later. Don’t let a single rejection stop you from getting the benefits you deserve.
When It’s Time to Get Help
You don’t have to go through this alone. Fighting a denial can feel like an uphill battle, but it’s a battle worth fighting. At Feldman Legal Group, we understand what’s at stake for you and your family. We’re here to make sure your voice is heard and your rights are protected.
Reach out today for a consultation, and let’s talk about how we can help you get the benefits you deserve.
(877) 946-8293