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The Process of Appealing an ERISA Claim Denial

When you've dedicated your life to your job, only to find yourself unable to work due to a disability, it's a difficult and disheartening situation. If your long-term disability insurance claim has been denied, you may feel like you're at the end of your rope. But don't lose hope. The Employee Retirement Income Security Act (ERISA) provides a process for appealing such denials, and with proper guidance and preparation, success becomes more likely.

Understanding the Denial

The first step in appealing an ERISA claim denial is understanding why your claim was denied in the first place. Your insurer is legally required to provide a written explanation of their decision. This document will outline the reasons for the denial, ranging from insufficient medical evidence to issues with policy coverage. This letter must also provide you with information on how to appeal the denial of benefits.

Reviewing the Policy

After understanding the reasons behind the denial, it's essential to review your disability insurance policy. Familiarize yourself with the policy terms, conditions, and exclusions. This will help you understand the evidence you must provide to appeal the denial successfully.

Gathering Additional Evidence

You might need to gather additional documentation if your claim was denied due to insufficient medical evidence. This can include further medical records, testimonials from healthcare professionals, or even an independent medical examination.

Preparing Your Appeal

Once you have all the necessary evidence, it's time to prepare your appeal. This should be a comprehensive document that counters each point made by the insurer in their denial. Ensure that your arguments are clear, concise, and backed by evidence.

Remember, the appeal process is not just about proving your disability but also about demonstrating that the insurer's decision was unreasonable based on the medical and non-medical information available.

Submitting Your Appeal

After your appeal is ready, you’ll need to submit it to your insurer within the time frame specified in your policy. Under ERISA, an appeal must be submitted within 180 days of the written denial letter. It's crucial to adhere to these deadlines, as late submissions can result in a forfeit of your right to appeal or pursue the claim further.

Help from an Attorney with Expertise in Disability Insurance

Disability insurance law is complicated. If your claim for long term disability benefits was denied or being delayed by an insurance company, it is important to get help from a lawyer with expertise in disability law.

Why Us?

  1. Our lawyers specialize in disability insurance;
  2. Our lawyers have experience with UNUM, Hartford, CIGNA, Reliance Standard, and just about every other insurance company;
  3. Our lawyers have won tough disability insurance lawsuits;
  4. Our lawyers have recovered millions in disability benefits for clients who were wrongly denied.

Because federal law applies to most disability insurance claims, we do not have to be located in your state to help.

Dabdoub Law Firm represents clients nationwide with:

  • Submitting a disability insurance claim;
  • Appealing a long-term disability denial;
  • Negotiating a lump-sum settlement; or
  • Filing a lawsuit against your disability insurance company.

Call to speak with a disability insurance attorney. No fees or costs unless clients are paid.

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