When you elect to have disability insurance through your employer, you are being mindful of what the future might hold and being responsible. In doing so, you trust that you would be able to use this valuable benefit if and when the time came. Unfortunately, when you became sick or injured and left unable to work, you submitted your claim accordingly and were denied. You may feel like there is no hope or no other options. However, you do have the right to appeal this decision. ERISA disability appeals are a potentially powerful option available to you, and hiring a veteran ERISA disability appeals attorney can help you properly prepare your appeal.
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Right to Appeal Your Denial
The Employee Retirement Income Security Act of 1974 (ERISA) sets the laws for insurance plans that employers provide, such as health, life, and disability. Under ERISA, applicants have the right to an appeal if their claim is denied.
Being denied ERISA disability is far more common than some people might expect. In fact, one study found that from 2006 to 2015 only 23% of applicants were approved upon their initial application. In light of this, applicants can and should submit an appeal if they are denied ERISA disability benefits.
Appeals Deadlines and Rules
ERISA disability appeals can be a complicated process often best overseen by an attorney experienced in this field. Primary factors in this complexity include the strict deadlines and rules for appealing a claim for ERISA benefits.
For instance, if an appeal is denied and an applicant subsequently takes their case to trial, no new evidence can be submitted at that point. This means it is often critical to submit as much quality information and evidence during the initial application and appeal as reasonably possible.
The clock starts ticking once an applicant receives their letter of denial from the insurance company. This letter should include certain details about why the disability claim was denied, as well as the specific policy provision for denial, whether the applicant can provide additional materials or evidence to make their claim valid, and directions for how and where to file an appeal. In addition, this denial letter should include information on the applicant’s right to bring a lawsuit under ERISA law.
Following receipt of this letter, applicants have 180 days to file your appeal. Once the appeal request is received, a decision will typically be made within 45 days, although, the law does allow for two 30-day extensions under qualifying circumstances. If the appeal is denied, some insurance companies have provisions that require applicants to appeal a second time. Other insurance companies do not, however, meaning they could move on to a trial at that point.
Get an ERISA Disability Attorney to Help
