Provided by the attorneys of Niedweske Barber, New Jersey Benefits blog is your resource for updates and expert analysis on all issues relating to ERISA in the state of New Jersey.
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Tuesday, May 18, 2010 at 5:48:08 PM by Matthew Vance
Compensable Disability in Cases Involving Fibromyalgia, Complex Regional Pain Syndrome, Reflex Sympathetic Dystrophy, and Chronic Fatigue Syndrome
Many health conditions (such as bone fractures and high cholesterol) can be diagnosed easily and definitively. Other disabling conditions, however, are not susceptible to such diagnostic tests. These difficult-to-diagnose conditions include:● Fibromyalgia
● Chronic Regional Pain Syndrome
● Reflex Sympathetic Dystrophy
● Chronic Pain Syndrome
Disability insurance companies want proof that a person is actually disabled before they start paying monthly disability benefits. But proof can be hard to come by when no diagnostic test is available for the condition. In this office, we have found that a claimant can take simple, practical steps to prove that disability exists, even where you suffer from Fibromyalgia and related syndromes. This evidence can be any (or all) of the following:
● Medical diary
● Personal journal
● Claimant video
● Claimant’s affidavit
● Witness statements
Evidence such as that described here can be acquired inexpensively and in short order. Such evidence can be effective in demonstrating the presence of a disabling condition, intensity of the symptoms, and that the symptoms are not being overstated by the claimant.
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Show All » Benefits Law » Employer Insurance
Saturday, April 03, 2010 at 7:28:43 PM by Matthew Vance
Claim Denied!: Deadlines for Appealing the Denial of Fringe Benefit Claims
If you have received a claim denial from your employer’s insurance company, it is imperative that you appeal that denial in a timely manner. If you do not challenge the insurance company’s denial, that will create problems down the line. This article discusses the time periods for appealing denial of health insurance, long-term disability insurance, and severance.Fringe benefits you receive from your employer (health insurance, long-term disability, and severance) are subject to federal regulations. If you receive a denial, the regulations provide for the following deadlines:
| TYPE OF BENEFIT | DEADLINE FOR APPEALING | REGULATORY AUTHORITY |
| Severance Benefits | 60 days | 29 C.F.R. § 2560.503-1(h)(2)(i) |
| Long-Term Disability180 days | 180 days | 29 C.F.R. § 2560.503-1(h)(4) |
| Pension Benefits | 60 days | 29 C.F.R. § 2560.503-1(h)(2)(i) |
| Health Insurance | 180 days | 29 C.F.R. § 2560.503-1(h)(3)(i) |
| Life Insurance | 60 days | 29 C.F.R. § 2560.503-1(h)(2)(i) |
Keep in mind several pointers when you receive a claim denial for any of these types of benefits:
- The time deadlines noted above are counted beginning on the date you receive the denial, rather than when the claim denial is mailed to you.
- Long-term disability appeals, when undertaken properly, are complex, time-intensive endeavors, hence the long appeal period. You will need all of the 180-day period to perfect your appeal. As such, start working on your appeal immediately after receiving the denial.
- If you find yourself precariously close to the appeal deadline, there is nothing in federal law which prohibits you from contacting the individual who signed the denial to request an extension. Of course, nothing requires the insurance company or administrator to grant the extension. But at this law firm, we have frequently requested extensions on behalf of participants who come to us late, and many of those requests have been granted.
The U.S. Department of Labor (“DOL”) publishes a summary guide for fringe benefit claims and appeals. Keep in mind that the DOL guide is geared toward health insurance claims, denials of which are appealable within 180 days of denial.
The ERISA attorneys at Niedweske Barber have encountered hundreds of fringe-benefit claim denials. For assistance with your claim and appeal, contact our ERISA paralegal, Mary Machette.
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Show All » Benefits Law » ERISA
Saturday, April 03, 2010 at 7:23:36 PM by Matthew Vance
ERISA Disclosure Requirements
ERISA plan participants have a statutory right to disclosure of basic documentation concerning their employer-sponsored group benefits. A pension plan participant, for example, is entitled to, among other items, a Summary Plan Description (summarizing – as its title suggests – the plan’s rules and regulations), an Individual Benefit Statement (depicting the amount of benefits in the retirement account), and a statement concerning the plan’s solvency. The U.S. Department of Labor has published a useful pamphlet describing these disclosure requirements: Reporting and Disclosure Guide for Employee Benefit Plans, U.S. Department of Labor, Employee Benefits Security Administration (October, 2008)Top
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