8 Common Mistakes With An ERISA Disability Appeal

September 15, 2020 | J. Price McNamara
8 Common Mistakes With An ERISA Disability Appeal

Your ERISA disability appeal is your last chance to provide evidence to support your disability claim. Given the importance of the appeal process, you should make every effort to ensure that your appeal is well-organized, complete, and supported by convincing evidence. This is not always easy, especially if you try to handle the appeal process on your own without legal guidance. Below are 8 common mistakes made with an ERISA disability appeal.

1) Failing to carefully review your policy

The path to a successful appeal begins with a clear understanding of your long-term disability policy. If you have a copy of your policy on hand, then take the time to read it from top to bottom. If you don't have a copy, you can typically request one from your HR manager or benefits plan administrator. You may also be able to access a copy through your company's online web portal.

2) Not contacting an ERISA lawyer as soon as possible

Hiring an ERISA disability benefits lawyer will boost your chances of a successful appeal. You should hire a lawyer as soon as possible because there is a timeline with the appeal process that you must follow. Here are some specific ways an ERISA lawyer can help your appeal:
  • Identify important information that is missing from your claim
  • Gather and present new evidence that supports your disability
  • Uncover flaws with the insurance company's decision
  • Ensure that you file your appeal on time
  • File a lawsuit if your insurance company continues to deny your claim

3) Procrastinating or delaying your appeal

"You have at least 180 days to request a full and fair review of your denied claim. Use your plan's appeals procedure and be aware that you may need to gather and submit new evidence or information to help the plan in reviewing the claim." - Employee Benefits Security Administration, United States Department of Labor
When your claim is denied, you should receive a letter that clearly outlines the deadline for filing your appeal. If you wait until a day or two before your due date to begin organizing your appeal, you will likely find that you don't have enough time to gather the new evidence that you need to support your claim.

4) Failing to follow your plan's appeals procedures

Your insurance plan will clearly outline the steps you must follow to file claims and appeals. It is your responsibility to familiarize yourself with these procedures and adhere to them. Failure to follow your plan's procedures could cause your claim or appeal to be denied.

5) Not using certified mail to send documentation

You could have the most impressive, well-organized appeal in the world. But your hard work could be in vain if your paperwork never reaches the appropriate party. Any hard copies of your appeal or associated documentation should be sent by certified mail with return receipt requested. Always keep at least one copy for your records in case any information is lost in transition.

6) Failing to follow up on your ERISA disability appeal

When your appeal is received, it will be reviewed by a different person than the individual who initially reviewed your claim. All information that you provide should be reviewed and a decision will be rendered. There are deadlines for reviewing appeals and plans cannot extend these deadlines without your consent. If you fail to receive a decision within the timeframe specified by your plan, it is wise to speak with an ERISA attorney.

7) Turning to your HR manager for guidance

Human resource managers are often responsible for distributing general information regarding employee benefits. However, this does not mean they are experts in disability law or insurance issues. Asking an HR manager to interpret an insurance policy or help you with your ERISA disability appeal is usually not a good idea.

8) Assuming you have enough evidence to support your appeal

One of the worst things you can do when filing an appeal is to assume that you have enough information to convince the reviewer to approve your claim. And you should never expect your claim to be approved during the appeal process simply because there will be a new person reviewing your claim. If you are on the fence about whether a letter or document will help your case, it is usually best to include it, as a comprehensive approach is typically best.

What is the best way to avoid these mistakes?

Seeking the expertise of an experienced ERISA lawyer is the best step you can take to avoid the pitfalls above. With an ERISA disability appeal lawyer handling your appeal, you can rest assured that you do not miss any key deadlines and filed according to the proper procedures. More importantly, an attorney will ensure that your appeal is professionally organized and includes the proper documentation. With an experienced lawyer in your corner, you will maximize the chances that you receive the disability benefits you deserve.  
J. Price McNamara Author Image

J. Price McNamara


Losing my own brother, then my father and sister after long, disabling illnesses just a few months apart drove a career change for me. Before that experience, I never truly understood the place you’re in. I never understood the dramatic impact that receiving (or not receiving) the disability and life insurance benefits you paid for and counted on can have on your life especially when you need to focus on family and healing. What I experienced with my own family now drives the way I view my clients and my work, and I will never forget it!

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