ERISA Disability Appeal
If your long term disability insurance claim has been denied, then I know that you will find some relief after speaking with one our disability attorneys. Our law firm’s goal is to get your disability insurance benefits reinstated and paid until you decide that you can work. We win more than 75% of our disability appeals and we have represented thousands of claimants with their ERISA governed disability appeal and/or lawsuit since 1979.
We have provided below multiple videos for you to learn about ERISA appeals and our experience in handling these disability appeals against every disability insurance company.
- Why You Need An ERISA Disability Lawyer
- Are ERISA Law Changes Good for Claimants?
- Top Reason for Disability Denial
- The Trap… Do Not Rush Your Disability Appeal!
- Are FCE Exams Helpful to Prove Disability?
- Senate Testimony On Disability Company Abuses
- A Judge’s Perspective on ERISA
- Disability Company Medical Reviews Are a Sham
The challenge is that The Employee Retirement Income Security Act of 1974 (ERISA) is a horrible nationwide federal law that gives disability insurance companies an unfair advantage over disability insurance claimants. If you obtained either your short or long-term disability insurance coverage as employee benefit through your employer then your disability claim will be governed by the ERISA. The ERISA regulations for disability claims were modified in 2018, but these changes have only made it more difficult for claimants to win appeals and prevail in litigation.
The Insurance Companies
Our lawyers know the claim handling techniques of every disability insurance company and we are highly skilled at defeating them at their own game. Through our personal experience we have created and constantly maintain the most extensive resource on the internet for information about every disability insurance company. We want you to search below to learn as much as possible about your disability company, review our resolved cases against your insurance company and our experience in helping people with a situation similar to yours.
The ERISA Facts
If your ERISA governed long-term disability claim has been denied following your initial application for disability benefits, ERISA regulations require the insurance company to establish and maintain a procedure by which a claimant shall have a reasonable opportunity to appeal an adverse benefit determination to an appropriate named fiduciary of the plan, and under which there will be a full and fair review of the claim and the adverse benefit determination. This means that your ERISA appeal must be reviewed by a person different than the original person that denied the claim. The idea is that a claimant is supposed to receive a full and fair review by the insurance company when an appeal is filed. Many people want to sue their insurance company and not bother with an appeal, but the law requires at least one appeal be filed and possibly two depending on your disability policy language.
Why Is It Important To Submit a Great Appeal?
- The Trap… Do Not Rush Your Disability Appeal!
- An ERISA Appeal Must Be Perfect
The insurance companies want you to draft and submit your own appeal, but it is nothing but a trap. The information submitted in an ERISA disability appeal is extremely important, as all of the documents submitted become part of what is known as the “administrative record”. In the event that your ERISA appeal(s) are denied and a lawsuit is filed, the court in most cases will be limited to their review of the administrative record. This means that if you were to have surgery after a final appeal decision is made by the disability company, then the court cannot review or consider any information about the surgery if it was not presented during the appeal.
ERISA does not allow for a jury trial, therefore if a lawsuit is filed it will be decided by a Judge. A non-jury ERISA trial is usually a disadvantage for a claimant, because the Judge does not get to hear live testimony and the Judge is basically just reviewing documents in the administrative record. When submitting an appeal it is essential that a claimant submits every piece of information in support of a claim for disability benefits that the claimant would want a Judge to consider.
The submission of a great appeal is an art and our disability attorneys are highly skilled at knowing what needs to be in an appeal and helping claimants to obtain the information needed to have the best chance to win an appeal.
How Do We Help?
- Everything Must Be In the Appeal
In order to present our client’s appeal in a light most favorable to the insured, Attorneys Dell & Schaefer work very closely with our clients and their treating physicians, to ensure that the appeals are submitted with an overwhelming amount of information and detail. Every case is unique and we work with your doctors to prepare statements that are specific to your medical condition and occupation. We make sure that every possible piece of objective medical evidence is obtained and we often recommend additional medical testing that could help prove your eligibility for benefits.
In many cases, Attorneys Dell & Schaefer will retain a medical doctor or nurse to review all of our client’s medical records and make recommendations regarding additional evidence that would strengthen our client’s claim. The insurance companies often hire their own doctors to either review your records or examine you. We work very closely with your doctors and our nationwide medical experts to rebut the reports created by these insurance company hired gun medical doctors. In most disability appeals, Attorneys Dell & Schaefer will retain a vocational expert in order to determine what vocational skills a claimant can perform in light of the claimant’s medical restrictions and limitations. The vocational expert will also perform a labor market study in order to determine the availability of specific jobs in a particular market.
We spend a great deal of time explaining the occupational requirements of a claimant’s occupation in order to make the insurance company understand why a claimant cannot work. We have access to all available medical research and we often rely on medical studies as further support for a client’s restrictions and limitations. The drafting of personal statements and statements from co-workers, family members and friends can be an important piece of an appeal we submit for you. In certain appeals we will submit a custom video to further explain the difficulties you are experiencing. We exhaust every option in order to submit the best possible appeal for you. We think outside the box and when we finally submit an appeal it is hard for the insurance company to disagree with us.
What Are The Important ERISA Time Frames?
ERISA provides extremely strict guidelines and deadlines for disabled claimants seeking disability insurance benefits under their group policies. If sufficient information is not submitted within these timelines, a claimant may be forever barred from introducing the documentation to prove their disability. The disability insurance company is required to give a claimant 180 days from the date of initial denial to submit a first appeal. While 180 days seems like a long time to prepare a disability appeal, most of this time is required to submit an appropriate appeal. The appeal process is long because it often takes time to receive all of the claimant’s medical records, obtain new medical support and review the entire claim file provided by the disability insurance company. Once an appeal is submitted, the disability insurance company has 45 days to respond to a claimant’s appeal. However, the insurance company may request an extension for good cause. Attorneys Dell & Schaefer understand the importance of trying to obtain benefits for our clients in an expedient and efficient manner.
Frustrating as it may seem, the disability carrier will not tell you what is necessary to perfect your claim. Moreover, group disability income policies are drafted with ambiguous and confusing contractual terms. These ambiguities provide insurance companies with multiple reasons for delaying and denying disability income benefits. Furthermore, most policies provide the insurance company with full discretion in deciding whether sufficient information has been provided by claimants prior to approving a claim. Given the complexity of the legal issues involved and the tendency of insurance companies to vigorously defend claim denials, evaluation of any potential legal claim on behalf of an insured should be handled by a law firm experienced in ERISA disability insurance claims.
Attorneys Dell & Schaefer are available to provide you with a free consultation and review of your long term disability policy. Please keep in mind that there are time deadlines with ERISA disability claims and we must have sufficient time to evaluate your claim and take the appropriate legal actions on your behalf.