ERISA Disability Claim Appeals

An ERISA disability claim appeal often requires careful analysis, detailed investigation, and help from a skilled disability lawyer. If you or a loved one’s short-term disability (STD) or long-term disability (LTD) benefits were denied, don’t give up. Instead, speak to the experienced team at CJ Henry Law Firm. We can help you regain control of your situation and protect yourself after a health crisis.

What Is ERISA?

ERISA stands for Employee Retirement Income Security Act of 1974, and it’s a federal law that governs group disability benefits and sets the standards for the administrators of your plan. Since ERISA disability is obtained through your employer, rather than individually, it is a complex federal law that can be difficult to understand unless you are completely familiar with it. ERISA sets out a series of procedures and requirements that every disability claim and appeal must follow. Unfortunately, some of these requirements put disabled workers at a disadvantage. For example, during your appeal, you won’t have a real trial that includes a jury or witnesses. Instead, the judge is limited to reviewing the “administrative record,” which contains all of the evidence the disability insurance company reviewed. The insurance carrier has the advantage because the judge will review the case based on the documents they provide. You need someone who will help you get the evidence in the file you want the judge to see.

How Do I File an ERISA Disability Claim Appeal?

Before you file an ERISA disability claim appeal, you need to review a series of documents, assess your legal and medical evidence, and build a strong case for your eligibility. You must be well-prepared and have a carefully-built evidentiary record. Otherwise, a federal judge will only have insurance company documents to review if your appeal progresses. While nothing compares to the personalized advice and insight of a skilled disability lawyer, you should always follow these basic steps when filing a ERISA disability claim appeal.

Consult With a Lawyer Early On

Sometimes, if you wait until the very last minute to speak with a lawyer, it’s just too late. ERISA disability claim appeals aren’t as flexible as other types of claims. You need an experienced lawyer at your side from Day One of your appeal, helping you meet its legal requirements and building the strongest case possible under your circumstances.

Review Your Disability Policy Documents

Every disability plan sets out different definitions of disability and appeal processes. Before you file a single piece of paperwork, you need to review this information. You or your lawyer should request copies of the plan documents, including its summary plan description (SPD).

Request a Copy of Your Disability Claim Record

This is the all-important “administrative record” that the insurance company and the courts will base their decisions on. You’ll need to know what is — and isn’t — in this record. When your disability lawyer reviews this file, they will identify strategies that help strengthen your claim.

Stack Your Record With Supporting Evidence

During ERISA disability claim appeals, lawyers “stack” their clients’ records, submitting missing evidence and expert opinions that might change the insurance company’s mind or help a judge understand your situation. Stacking a record is an art, and you should always consult with an experienced lawyer before you try to do it yourself. Once you have performed these preliminary steps, you can start your formal appeal.

Understanding the Two Levels of the Appeals Process

Typically, there are two levels of ERISA disability claim appeals. First, there is an administrative, or insurance company appeal. At this level, you can still submit additional evidence, including medical records and expert opinions. In many ways, this is the most important part of the appeal process and it’s in your best interest to consult with an ERISA lawyer at this stage. Once you submit all of your information and a detailed written argument, the insurance company will review your claim again and issue another decision — either granting or denying your disability benefits. If the insurance company denies your appeal, which isn’t uncommon, you can then file an ERISA appeal in federal court. At this stage, the judge is limited to reviewing the evidence in your administrative record. No matter how important your new or missing evidence is, you won’t be able to submit it to the judge.  However, you will have a chance to file detailed legal briefs and responses to the insurance company’s claims. Your ERISA disability claim appeals lawyer will guide you through this complex and confusing process.

You Need an Experienced ERISA Disability Lawyer

When you work with the CJ Henry Law Firm, you have an experienced team of professionals on your side. We help our clients:
  • Obtain all of their plan documents and administrative records
  • Understand the insurance company’s reasons for denying their claims
  • Build strategies that help strengthen their claims and stack their records
  • Present legal and medical arguments that support their claims for benefits
  • Meet all of the legal requirements and deadlines involved in their unique claims
  • Understand the complexities of ERISA law and how it impacts their chances of winning
We are tireless advocates for the disabled. To learn more about our law firm and how we handle ERISA disability claim appeals, contact us today.

Consult With CJ Henry Law Firm Today

Our dedicated team is ready to talk with you and hear your story. To get started, simply complete our online contact form or give us a call.  

We Can Help!

If you’re feeling overwhelmed by a disability appeal, you’re not alone. ERISA disability claim appeals are complex and it’s almost always in your best interest to work with a skilled lawyer. That’s where ERISA lawyer Claudeth Henry can assist you. She has successfully handled thousands of ERISA claims and appeals, and some of her peers consider her one of the best attorneys in Florida with a complete understanding of the laws. She holds a Bachelor’s degree in nursing and is an experienced ERISA attorney, so her combination of legal and medical knowledge will give you the advantage you need. She will help increase your chances of winning your case!

Time is of the Essence

The timing of filing your appeal is critical and you can easily lose your case if it is not filed quickly. We will need to review your claim file, develop a strategy based on your unique situation, obtain additional evidence as needed, which may include medical records and information, functional capacity evaluation, vocational information, statements of witnesses, conducting medical and legal research and other arguments. The longer you wait, the more difficult your claim will be. Regain control of your ERISA claim today. When you work with the CJ Henry Law Firm, we’ll help you understand your filing deadlines and legal options. For a no-risk evaluation, contact us today!

If you’re in Ocala, Orlando, New Port Richey, Sarasota or the surrounding areas in Florida, call CJ Henry Law Firm, PLLC so we can get started on your ERISA Disability Insurance claim as soon as possible.

Thank you again for your help with my claim. Your help and guidance throughout this process were terrific. I had almost no desire to even start down this legal avenue, but once I found you(it took some persistence), I was confident I had the right attorney. During our first phone conversation, your questions were so much more targeted and relevant than what I'd heard before; it was obvious you were the disability attorney I'd been searching for. At our first in-person meeting, I was really impressed too. You quickly and accurately gave me an assessment of my claim and offered an estimate of what might lie ahead. You did so without intimidation or minimization of my concerns, and I really appreciated that. I, clearly, was not eager to pursue legal action, and I never felt like you were steering me or my case in a direction I wasn't comfortable with. In retrospect, I'm even more pleased with your decision to bring Eddie on board too; the results at settlement were entirely a reflection of the extensive time, thought, and effort you two put into all aspects of my case. As I sat in Eddie's office during the mediation, I was impressed with you two quickly referencing details of my case and using that material to advocate for me. Both of you knew the details of my case forwards and backwards. I'm so happy I was directed to you and your law firm! Everyone there is great-especially Dianne, who exchanged so many helpful emails with me. I always felt like you and Dianne were on top of everything, and I was happy not to know the nitty-gritty behind-the-scenes details. I was stressed enough as it was. All your clients should rest assured that they have a great attorney on their side. Your calm, approachable, friendly character makes you even better to work with. Thank you so much for your help with my case. Should any issues develop regarding other issues relating to my disability, I'll be sure to contact you.

Dr. Sanjay D.

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