YOUR ERISA APPEAL – WHY IS IT SO CRITICAL?
If you work for an employer most likely you are a participant in a group long-term disability plan. This plan provides benefits if you become sick or injured and unable to work on a full-time basis. If you for ERISA disability benefits and are denied, your ERISA Appeal is Critical.
ERISA or the Employee Retirement Income Security Act governs your claim for disability benefits. 29 U.S.C. section 1132 et. Seq. is the federal law that governs your claim, provides the rules of how your claim is handled and it is the same statue used across the United States.
If you received a letter in the mail or via the insurance companies web portal, stating your ERISA claim for either short-term or long-term disability benefits is denied, you have a right to an appeal. A few paragraphs from the bottom of the letter, it will tell you that you have a right to an appeal and gives you a time deadline in which you have to respond.
First of all, the most important thing is to file a timely appeal. Your deadline will be provided in the letter itself and will say either a specific date to file by or give you a specific amount of days in which to appeal from the date you receive the letter. Basically, insurance companies tend to give you 5 extra days from the date of the letter on top of the specific number of days provided to appeal your ERISA claim.
However, DO NOT just appeal. You are entitled to your entire administrative record, a fancy way of saying your claim file. That contains everything about your claim and can be used to help you perfect your appeal.
Secondly, the reason your ERISA appeal is critical is that it absent some very limited circumstances, you only get one chance to supplement the record to support your claim for disability benefits. If you do not provide everything or answer all of the potential issues the insurance company claims there are, then you will have holes in your claim should the matter proceed to trial.
Finally, the ERISA appeal is so critical because if the insurance company denies your appeal, your only remaining remedy is to file a lawsuit. So, if certain medical records or reports or tests etc… are not apart of your appeal, and they are not in the administrative record, they basically do not exist. What I mean, is that absent some extraordinary circumstances you can not submit additional information for the court to review to help your claim get approved.
If you have been denied your ERISA disability benefits please give me a call at no risk to you to see how we can best help you.
