What You Should Know About Filing an ERISA Disability Appeal

Posted on July 2, 2019 by cjblog

Private disability insurance companies do not make the process of filing a claim simple or easy. The standard of proof on your end is incredibly high. Most claims will be denied, or the insurance company will claim they require more information. For that reason, many people enlist the help of an ERISA disability appeal attorney to handle both the claims process and the appeals process.

A denial is not the end of the road. You can appeal the decision. CJ Henry Law Firm PLLC can guide you through the filing a claim with your ERISA disability insurance providers, as well as help you with your ERISA disability appeal in the event that your claim is denied. Contact us today to learn more.

What Is the Disability Appeals Process?

The process will begin after you receive your denial. Many folks elect to have a lawyer intervene at this point. If an insurance company has any valid legal reason to deny a claim, they will. It is important to understand that this is just another step in the process.

They must, however, provide you with that reason citing any provision in the policy that would render your claim invalid. In the denial letter, they will also inform you of your right to an appeal and how to file the appeal. If the insurance company requires more information, they will generally tell you what information you require to satisfy the provisions of the policy.

What Is the Deadline for an ERISA Disability Appeal?

Under ERISA law, the insurance company must give you 180 days from the date of denial to file an appeal. The insurance company has 45 days to respond to your appeal. They can also request two 30-day extensions if they have cause.

It is best to involve an attorney early in this process. Your attorney can use that 180 days to contact your doctors, other experts, and build your case. Depending on your policy, the next step is either to file a second appeal or go straight into litigation. This means preparing for a trial before a judge.

ERISA Disability Trials Are Held Before a Judge (Not a Jury)

Your case will be tried before a judge, not a jury. The judge will look over your claim file. Your ERISA attorney will argue that the insurance company wrongfully denied your claim. It is important to understand that the information contained in your claim file is all the judge will be considering. In other words, you are not allowed to submit new evidence during the trial.

This is why it’s very important to engage an attorney early in the process. We can help you build your case during the appeals process (or even before) in order to ensure that everything you need to prove your case is already there. Hopefully, the case will not have to go before a judge but, in many cases, it will.

What Will You Need to Prove Your Case?

Once your case goes before a judge it is no longer a question of whether or not you have a disability. The question the judge will answer is whether or not the insurance company unlawfully denied your claim. This presupposes that you provided the insurance company with the requisite information during the claims or appeals process. In order to file a successful appeal, you must provide the following:

  • Medical records. Your ERISA claims file should contain detailed reports concerning your medical condition. It should also include reports from doctors concerning the limitations resulting from your medical condition. Your doctors should also offer opinions on whether or not your condition will heal over time, get worse, or become permanent.
  • Claim related correspondence. Your claim file should also include any correspondence between yourself and the insurance company. This includes your denial letter, requests for more information, and anything else.
  • Information related to your job. You will need to submit a detailed report concerning your job and your duties. This may include information from immediate supervisors concerning your ability to perform those duties.
  • Functional capacity evaluation. An FCE should show that your individual disability prevents you from doing your current job.
  • Vocational expert evaluation. A vocational expert provides an expert opinion on why your disability prevents you from doing your job.

Speak to an Ocala FL ERISA Disability Appeal Attorney Today

At CJ Henry Law Firm PLLC, we can help you increase your chances of success in winning an ERISA disability appeal. Contact us today learn more.

This entry was posted in Blog by cjblog.