ERISA Disability Appeals: Know The Steps

If your claim for long-term disability insurance benefits is denied, the first step is to file an appeal.

Your group disability insurance plan will state whether or not you are permitted to file one or two appeals. The insurance company is required to maintain an internal appeal review process so that the insurance company employee reviewing each appeal is completely independent of the employee who originally denied your claim. In reality, the insurance company will often give strong consideration to the prior claim decision to deny or terminate a claim.

The rules for an ERISA appeal are extremely strict, with defined time frames. During an appeal, the claimant must present factual, medical, legal and vocational evidence to demonstrate how and why they are disabled and entitled to benefits under the plan. An insurance company cannot require the filing of more than two appeals.

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." Following the decision on appeal, a claimant will then be permitted to file a lawsuit against the insurance company. ERISA does not permit jury trials, so a lawsuit will be decided by a judge.

In the event that your ERISA appeal(s) are denied and a lawsuit is filed, the court in most cases will limit their review to the administrative record. This is why the appeal is the most critical time of the claim.

We Can Help You Develop Strong And Persuasive ERISA Appeals

In order to present a powerful and persuasive ERISA disability appeal, we work closely with our clients and their treating physicians to ensure that the information developed for the appeal contains great detail and a strong articulation as to the severity and degree of impairment and the impact upon our client's functionality.

We will also develop strong support for the vocational issues, focusing upon how and why our client cannot engage in work, or cannot perform the duties of either their own occupation, or any occupation, as that term may be defined in the policy, and may differ based upon insurer.

We Agree — The Process Is Not Fair

The entire process is stacked against the claimant. Courts reviewing ERISA disability lawsuits often act as a rubber stamp of the claim termination or denial. The appeal is the only opportunity to create a record for litigation with the hope that the court will be receptive to the demonstration of wrongful conduct by the insurer.

Lawyers who do not practice in this specific area of the law are not likely to be familiar with the restrictions. The ERISA appeals process is a significant part of the firm's long-term disability insurance practice. We continue to refine our best practices as the case law continues to evolve. Read more about our ERISA Appeals success stories.

There are additional considerations when submitting an ERISA appeal outlined here.

Our Attorneys Fight Back

Because of our experience in this area of law, we represent clients throughout the country from our office in New York. Call us at 866-504-8773 or email us to set up a free consultation.