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Tips to Help You Win Your ERISA Disability Appeal

ERISA Disability AppealYou expect that your insurance and retirement plans will be there to support you if and when disability strikes. Unfortunately, that’s not always the case. Nevertheless, you do have protection under the Employee Retirement Income Security Act (ERISA).

ERISA sets minimum standards that your retirement and other insurance plans must meet to provide you with adequate protection. When you file a claim, you expect that your plan will provide for you if you need it. But claimants often meet swift unreasonable denials.

As soon as possible after you receive a group disability denial, you need to speak with an experienced ERISA disability lawyer to get help with timely filing your comprehensive administrative appeal.

ERISA Administrative Appeals

Suffering a long-term disability is bad enough. Having your legitimate disability claim denied adds insult to your injury or sickness.

To deny your group ERISA disability claim, your provider must give you specific information, including:

  • Written notice of denial with specific reasons
  • List your next steps for review of the denial
  • Provide you at least 180 days to file an administrative appeal

If your provider fails to give you any of the above, your ERISA disability lawyer can take swift action on your behalf. When a provider does not provide an adequate reason for denial, many claimants mistakenly take that as the ultimate word. However, when you partner with an experienced long-term disability lawyer, your lawyer can fight for your best interests, hold the insurance company accountable and make them give specific and detailed reasons for denying your legitimate claim.

ERISA Administrative Appeal Deadline

It is vital to the success of your ERISA administrative appeal that you act fast. Like most legal proceedings, you have a very limited time to bring a comprehensive administrative appeal. When your long-term disability claim is denied, you have the right to file an administrative appeal. But you must do it within the timeline specified or you will lose all your rights.

If you miss this administrative appeal deadline, you may not have any other recourse. You could miss out on your ability to collect disability monthly benefits. To avoid this, work with a trusted long-term disability lawyer. Your legal representative will understand the short deadlines in your administrative appeal and meet those timelines.

Provide Necessary Information

One of the most common reasons why LTD insurance companies deny an ERISA claim is because you did not provide enough details, or the right information, in your initial claim application. That’s why it’s best to work with a long-term disability lawyer before you file your initial claim. Your lawyer can help ensure you provide accurate and complete occupational, medical, vocational and financial information to help you avoid a denial of your claim.

Even if you filed your claim on your own, getting the right lawyer to help with your administrative appeal is important. The ERISA administrative appeal is your last chance to submit evidence to support your claim. You do not want to mess this up, and having a trusted and experienced ERISA lawyer guiding you may give you the best chance of a successful outcome.

You need to make sure you provide complete medical information. You may have copies of your medical records but you should also get your complete file from your treating doctor. Your treating doctor or their office may need to write a comprehensive medical report outlining your care, treatment, medications, restrictions, limitations, why you are unable to work physically, mentally and cognitively. The more information you can provide about your long-term disability, the better.

You also want to provide testimonials. Describe in great detail how your long-term disability has affected your ability to live your life. Describe how you have not been able to work or had to reduce hours.

You also want to cite relevant statutory and case law. This is where the guidance of a skilled ERISA lawyer may help the most. Stating the reasons you believe you have a legitimate claim is important, and your lawyer can help boost your statements and reasons. By citing specific terms in your policy and referring to supportive statutes and case law, your lawyer can file the most comprehensive administrative appeal possible. Your lawyer has been down this road before, and they know what it takes to overcome a long-term disability claim denial. Your lawyer may also want to have a second expert evaluate you or have further objective testing along with a functional capacity evaluation or cognitive testing to evaluate your executive functioning and processing ability.

Communicate in Writing

Every communication you or your doctor has had with your provider should be in writing. You never want your administrative appeal to come down to something that was said over the phone, as there may not be a recording of your conversation.

Ensuring that you always correspond in writing also means that you have copies of all of your correspondence. You may need to rely on this during your administrative appeal. You also want to keep copies of any documents or letters you have sent, not just those you have received from your insurer.

Other Determinations

You may be able to further support your ERISA administrative appeal with determinations from other agencies. For example, if you filed a Social Security Disability claim and your claim was approved, you could use this determination to help prove your inability to perform the important duties of your occupation and improving your chances of a successful administrative appeal.

Claim approvals from your state disability fund or workers’ compensation may also help in your ERISA administrative appeal. To be sure, you need to speak with an ERISA attorney as soon as possible. They will need to review the claims you filed with other agencies and review their decisions. There may be information in those decisions that will help overcome the denial of your ERISA disability claim.

Get the Necessary Help

Attorney Frank Darras
Attorney, Frank N. Darras

Your ERISA administrative appeal is the very last chance you have to make your case because whatever information is not included with the administrative appeal will not be considered. Do not try to do an administrative appeal alone. Partner with a skilled and experienced ERISA long-term disability lawyer to ensure you provide complete and supportive evidence of the legitimacy of your claim.

Do not wait. Your lawyer needs time to put your administrative appeal together, collecting all of the relevant evidence and reviewing the exact terms of your policy. You already have a tight deadline for your administrative appeal, so giving your lawyer as much time as possible to compile the necessary information is paramount to the success of your administrative appeal. Contact DarrasLaw for a free consultation today.

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DarrasLaw is Americas' most honored and decorated disability litigation firm in the country. Mr. Darras has seen more, evaluated more, litigated more, and resolved more individual and group long term disability and long-term care cases than any other lawyer in the United States.

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