No one is immune from everyday pitfalls and mistakes that everyone is bound to make, but there are some avoidable ones I see over and over again.
Applying for disability benefits before reading the disability insurance policy. I tell my clients that applying for disability benefits without reading your policy is like playing baseball where only one team has the rule book. Your disability policy governs your claim. It tell what it means to be disabled, how benefits are calculated, the deadline to provide proof of claim, limitations on benefits and much, much more! Wouldn’t it be devastating to make the difficult decision to leave your job, apply for benefits, and then find out your condition is limited or excluded by your policy? Get your policy before you even apply and don’t just put it aside, read it!
Appealing a denied disability claim without getting a copy of the claim file. In ERISA claims, the claim file will be the evidence presented to the Judge. It consists of all the evidence the insurance carrier has gathered about you: medical records, surveillance, notes from telephone calls, their in- house doctor’s report. You cannot adequately challenge the denial without knowing what’s in the claim file. Get your claim file; do it right away as soon as you get the denial and go through it with a fine tooth comb.
Failing to present additional evidence to support your appeal. This is the evil twin of #2. In addition to failing to get the claim file, many fail to send in additional or useful evidence to support their claim. Just sending a note threatening to sue, or saying the same thing as before will not cause the insurance company to change their position. Most importantly, by doing so, you have lost your last chance of presenting evidence that will be presented to the Judge, since that letter will be considered your appeal.
Saving best evidence for trial. In ERISA claims, there is NO TRIAL, not as most people know it! Chances are you will never be called to testify, your doctors won’t be able to go to court and testify as to how disabled you are, and you can’t call friends, relatives, or co-workers to testify how you can’t do your job. These are administrative procedures. A Judge, not a jury, will decide your case based largely on your claim file put together by – you guessed it – the insurance carrier! You want to make sure all the evidence you want the Judge to see is in that file before the record is closed!
Missing deadlines or waiting too long to get legal help. This can be fatal to your claim. ERISA is an unforgiving law. You must exhaust the administrative remedies before the claim can be filed in court. That means you must appeal the denial first. If you miss your deadline, you could conceivably lose your right to present your claim in court. Preparing a comprehensive appeal is time consuming, and not all lawyers handle ERISA disability claims. Get competent legal advice as soon as you get that denial letter.
As you can see, there are many costly mistakes that are entirely avoidable.