When you’re faced with filing an ERISA disability appeal, the process can be lengthy and complicated – just like its name. ERISA stands for the Employee Retirement Income Security Act of 1974 and was originally enacted to protect employees from the mismanagement and abuse of their employee benefits.
While ERISA is there to protect you, there is no guidebook to help you interpret the law or help you draft a persuasive appeal.
To help you with the ERISA appeal process, we’ve put together these seven tips.
7 Tips for Your ERISA Disability Appeal
1. Understand the ERISA appeal process
The process of filing a long-term disability appeal on an ERISA-governed policy can differ slightly from case to case. But in every case, an appeal must proceed through an administrative appeal process as required by ERISA.
All ERISA-governed policies must do the following in the event of a denial of long-term disability benefits:
- Provide adequate written notice with reasons for a benefits denial
- Create internal procedures for the review of their denial or determinations
- Provide at least 180 days to file an appeal any denial of benefits
Failure in either of these areas is something that an experienced ERISA disability lawyer will immediately recognize. They will help you make clear to your insurer that they cannot deny you your benefits due to their poor communication, failure to follow the required process, or not giving your claim the detailed examination it was due.
2. Don’t miss your appeal deadline
The appeal process is precise and on a strict timeline for both parties.
ERISA law requires that someone with an ERISA long-term disability policy must engage in the policy’s internal review before bringing a lawsuit to court. This requirement means that if a claim for long-term disability benefits is denied, you have the right to an ERISA appeal. You should file with the claims manager of the policy within 180 days.
If you miss the appeal deadline, you are not allowed to file a lawsuit and your case is over. There are few exceptions.
When you file your ERISA disability appeal, the claim should be evaluated within 45 days after it is received. There are ways the insurer can extend that timeline, but the extensions must have valid reasons. The insurer cannot simply sit on your appeal until they feel like handling it.
3. Submit as much evidence as you can to support your claim
The ERISA appeal is the last chance you will ever have to submit evidence to support your claim.
If you meet the appeal deadline but are still denied, then you are allowed to file a lawsuit. However, the court will only look at the evidence in the insurance company’s claim file when deciding your case.
The ERISA appeal is the last chance you will ever have to submit evidence to support your claim.
Therefore, while you can file your ERISA appeal yourself, an attorney’s help at this stage is invaluable. Unless you are an attorney in this specific area of law, there are too many errors to be made, and once the appeal is over they are not recoverable.
4. Support your medical condition
Submit all your medical records, and describe how your medical condition has had on your life and ability to work. Be thorough and detailed.
5. Make sure to cite the policy and relevant case law
Don’t just state the reasons why you believe your insurance policy covers your claim. Show them by citing the relevant policy terms, and any case law that supports your interpretation of the policy.
6. Get the help of your medical providers
If possible, obtain the support of your physician(s), especially if you have a good relationship with your doctor. Some physicians will even review the appeal letter and write supportive statements on your behalf.
7. Make sure to always communicate in writing and keep proof of delivery
Send all correspondence, especially your ERISA disability appeal letter, to your long-term disability insurer by certified mail with a return receipt requested. Make sure you keep copies of all documents you have sent.
How a long-term disability lawyer can help you with your case
As mentioned above, your ERISA disability appeal is the last chance you will ever have to submit evidence to support your claim. An experienced ERISA attorney in this area will make sure all relevant evidence gets submitted so you will have the best chance to win if your case ever goes to trial.
Further, as mentioned above, ERISA contains strict timelines and deadlines. An ERISA lawyer will know these requirements and make sure you make all deadlines and preserve your chance to go to court.
Don’t wait until the last minute to speak with an expert
If you have a long-term disability claim that has been wrongfully denied, talk to Roy Law Group. Our compassionate team of expert lawyers knows ERISA and long-term disability law inside and out, and we are here to fight on your behalf.
Contact Roy Law Group right away to set up your consultation.
For additional information on timelines and other requirements for filing a disability appeal, you can download this guide from the U.S. Department of Labor: Filing a Claim for Your Disability Benefits [PDF].