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Why should I hire a disability insurance attorney to submit my ERISA Appeal?


  • Why should I hire a disability attorney to submit my ERISA Appeal?
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Disability attorney Stephen Jessup discusses the benefits of hiring a disability attorney to submit your ERISA appeal.

After your claim has been denied through an ERISA group policy, the most important part of your claim at that time is the actually filing of your appeal. When you receive your denial letter, the denial letter often says, “If you disagree, you have 180 days to appeal our decision and tell us why.” A lot of times, we see an individual just write a letter, “I don’t agree. I want you to reconsider,” not realizing the ramifications of that and what the appeal really means.

That appeal is your chance; that’s setting up your argument for any future litigation in the matter. If this goes to court after if they deny it and it has to litigation, it goes before a judge, a federal judge. You have no jury, the judge won’t hear any testimony; he’s going to review what’s in the administrative record. The administrative record is comprised of what the insurance company has in their claim file and what you submit as additional evidence in support of your claim in your appeal.

If your appeal isn’t filled with the type of objective tests the insurance company may say were lacking, or you don’t supplement with additional records, maybe medical records were never sent to the insurance company for review unbeknownst to you. So in the event that that information isn’t contained and presented in your appeal, after the insurance company makes its final determination, you could realistically have a heart attack three days later and that may never make it into the administrative record for the judge to consider. So you have to see it as a very small snippet in time.

That appeal, your whole claim, is only going to go up to that last determination. It may be a year until you see a judge and it goes technically to trial. The judge won’t consider anything for that year, so your only chance, your time to tell the judge your story or to really put in all the information you can is during that appeal. That’s why it’s so important to hire an attorney. If your claim has been denied, I strongly, strongly advise that you contact our office; we can review your denial letter and your policy, and let you know what your options are and how we can help you.

There are 2 opinions so far. Add your comment below.

Ashley J.:

I have been on short term disability since september 4, 2014 secondary to spinal fusion surgery. I am a RN and when the physician’s office stated that I could return to work on light duty my employer did not allow me to return to work at that time. The employer’s policy was that you have to be fully released to return to your job so I had to remain off work. My employer then terminated me stating they needed someone in my position immediately and could not wait for me any longer. Lincoln financial group is the short term disabiliy company my employer used and they continued to pay me disability up until December 15, 2014 the last appt. date I had with my neurosurgeon. At that time my physician stated in writing for me to continue to remain off work until I see them again on January 26, 2015. That note was sent to lincoln financial group to my claim worker. No one from lincoln finacial called or notified me that they needed more information from the neurosurgeon to consider my extension of benefits. I called my claim worker the week of christmas and she stated at that time they needed the actual visit note to extend my claim so I drove 80 miles to the neurosurgeon’s office on Dec. 29,2014 and obtained this note and had it sent to lincoln financial group. My claim worker told me at that time the note was what she needed and I unfortunately assumed that a check would come to me the next week. However, I received nothing and as a result called my claim worker and she then told me that my “extension” had to be reviewed by the medical team now and even then did not tell me it would take weeks for them to review one page of a physical therapists note from the physician. I called every day to check on the progress and got no where with them, but did speak to the 800 number instead of my claim worker on two occasions because she did not return my call and it was that person that informed me of the length of time a medical review can take. I asked to speak to my claim worker’s supervisor at that point and left messages and no one returned my call and this week the supervisor has been out sick. I spoke with my claim worker just this morning again to inquire if a decision had been made and she now told me my extension is “still denied” which no one told me previously that it had been denied and even though they got another bit of information from the neurosurgeon’s office this week it is still denied and I would be receiving a letter in the mail and a form to appeal I informed the claim worker that I would have an attorney fill that out and contact Lincoln financial group on my behalf. I am going to need a disability attorney that can do that for me.

Attorney Stephen Jessup:

Ashley,

Please contact our office when you receive a copy of the denial letter to discuss how we can assist you in appealing the denial of your claim.

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