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

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.

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There are 2 comments

  • 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.

    Stephen JessupJan 15, 2015  #2

  • 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.

    Ashley J.Jan 14, 2015  #1

FAQ

Do you work in my state?

Yes. We are a national disability insurance law firm that is available to represent you regardless of where you live in the United States. We have partner lawyers in every state and we have filed lawsuits in most federal courts nationwide. Our disability lawyers represent disability claimants at all stages of a claim for disability insurance benefits. There is nothing that our lawyers have not seen in the disability insurance world.

What are your fees?

Since we represent disability insurance claimants at different stages of a disability insurance claim we offer a variety of different fee options. We understand that claimants living on disability insurance benefits have a limited source of income; therefore we always try to work with the claimant to make our attorney fees as affordable as possible.

The three available fee options are a contingency fee agreement (no attorney fee or cost unless we make a recovery), hourly fee or fixed flat rate.

In every case we provide each client with a written fee agreement detailing the terms and conditions. We always offer a free initial phone consultation and we appreciate the opportunity to work with you in obtaining payment of your disability insurance benefits.

Do I have to come to your office to work with your law firm?

No. For purposes of efficiency and to reduce expenses for our clients we have found that 99% of our clients prefer to communicate via telephone, e-mail, fax, GoToMeeting.com sessions, or Skype. If you prefer an initial in-person meeting please let us know. A disability company will never require you to come to their office and similarly we are set up so that we handle your entire claim without the need for you to come to our office.

How can I contact you?

When you call us during normal business hours you will immediately speak with a disability attorney. We can be reached at 800-682-8331 or by email. Lawyer and staff must return all client calls same day. Client emails are usually replied to within the same business day and seem to be the preferred and most efficient method of communication for most clients.

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I had a very good experience. Rachel and Danielle were incredibly professional. They gave me a clear understanding of the process and timelines. I feel they are there fighting for me everyday. The process overall was very simple and enabled me to focus on my illness.

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