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Marc Whitehead
Board Certified-Personal Injury Trial Law
Texas Board of Legal Specialization

 

 

 

 

Appealing ERISA Disability Claims

ERISA Disability Claim Denial

Has your claim for long term disability been rejected (or terminated) by your insurance company? If this is your situation, do not lose hope. If you worked for a company that provided a group disability policy for its employees, we can help you.

While insurance companies repeatedly reject claims, this does not mean those cases will automatically be defeated on appeal. You still may have a valid case that can be won. As an ERISA claim attorney I can help you take immediate action in ERISA disability disputes to appeal your claim.

ERISA Law

Most group disability policies provided by employers are regulated by a federal law, the Employee Retirement Income Security Act, known as ERISA. Your rights in ERISA disability claims are different (more restricted) than insurance claims governed by state laws.

Few employees have even heard of ERISA until they have been denied an insurance benefit. As a mater of fact, most attorneys are not familiar with the differences and complexities in ERISA governed claims.

When faced with a denied disability claim that falls under ERISA law, it is imperative that you have an experienced ERISA claim attorney representing you.

ERISA Disability Claims Process

Filing for disability benefits is a complicated process, and the legal translation of “disability” in determining eligibility for benefits is subject to interpretation.

The definition of "disability" changes in most insurance policies over a measure of time - typically after 2 years - from being unable to perform one’s own occupation to being unable to perform any occupation. Insurance companies often cancel claims for long term disability after the expiration of the initial own occupation definition of disability.

The Importance of Administrative Appeal in ERISA Disability Claims

The administrative appeal is a required step under ERISA legal procedure. When an ERISA disability claim is denied, as the claimant you must appeal directly to the insurance company. The insurance company must in turn explain to you the reason for their denial.

When you appeal the denied claim, it is critical to be aware of the requirements and hazards that lie ahead. There are strict guidelines and deadlines to be met, and the insurance company most likely will not have your best interests in mind.

You generally have only 180 days to file an administrative appeal of the denial. In ERISA disability claims, the administrative appeal is gravely important to your success. This appeal is, as a general rule, the only opportunity you have to submit key evidence of your disability into the records.

If a lawsuit is necessary later on, in most cases the only evidence considered at trial is the evidence submitted during the administrative appeal. You will not be allowed to submit this evidence later in trial before the Court. Therefore it is important to “load the record” with medical and vocational evidence favorable to your claim.

Medical and vocational evidence of disability is generally in the form of:

  • medical opinion evidence
  • vocational expert reports
  • objective medical testing
  • residual functional capacity reports
  • job description evidence under the federal government’s Dictionary of Occupational Titles
  • affidavits of the claimant and key witnesses.

A critical mistake made at this level of appeal is not submitting this key evidence. Any evidence you fail to provide during the administrative appeal will not be considered in your case as proof of your disability.

We have seen unrepresented claimants and inexperienced lawyers make this mistake repeatedly. A skilled ERISA lawyer can help you avoid serious errors in the appeal phase.

Before filing a lawsuit against your insurer, ERISA law requires that you first exhaust all internal administrative remedies.

If your claim continues to be denied by the insurance company, you may file a lawsuit. The suit for recovery of disability benefits occurs in court before a judge (no jury) who will review only the existing administrative records.

Help for ERISA Disability Income Claimants

In spite of these obstacles, we are able to help people who are disabled from working to prove their disability and win their case. The appeals process is your opportunity to overturn the insurer's initial decision to deny your claim.

If your ERISA claim has been denied, contact our office immediately.

Click here for a Free Consultation with a lawyer who will evaluate your ERISA disability claim, or fill out the Free Consultation form on the right side of this
website. Don't Give Up! Call for a Free Consultation.

Your best move is to hire a veteran ERISA claim attorney to battle the insurance company on your behalf. With our skills and experience behind you, you send a message to the insurance carrier and its attorneys that you are not going to be manipulated out of your rightful compensation.

Learn more about disability income and ERISA.

Disability Questions & Answers.

 

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Click here for the free Disability Insurance Policies Report.

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  • Social Security Disability
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