If you have a long-term disability claim that is denied, you have a right to appeal. An experienced ERISA appeals lawyer knows how to successfully appeal disability denials. The federal law known as the Employee Retirement Income Security Act or “ERISA” governs most group disability insurance policies.
If a disability claim is denied, ERISA requires you be given an opportunity to appeal that decision to the insurance company. The appeal is required to be done before you are allowed to file a lawsuit in court. This is known as “exhausting administrative remedies.”
How Disability Insurance Companies Use ERISA
ERISA requires that you be given at least 180 days to submit an appeal. The disability insurance company’s denial letter should state how much time you have to appeal and give the specific reasons why your disability claim was denied. The insurance company has 45 days to make a decision on the appeal. ERISA allows an extension of 45 days if “special circumstances” prevent the disability insurance company from making a decision.
Insurance companies know how to use ERISA to its advantage. It may use your appeal to build a stronger case against you. It can do this by:
- Contacting your doctors without your knowledge
- Doing surveillance of you
- Sending you for a medical examination with its own doctor
The disability insurance company’s doctor will also review your medical records and prepare a report about you.
If the appeal is denied, ERISA generally does not allow you to submit any additional information in court. You will be stuck with the information already in the disability insurance company’s claim file. This is why it is important that the appeal be handled properly.
If you have you submit a disability insurance appeal, you should contact a ERISA lawyer experienced with ERISA. The Dabdoub Law Firm, Disability Insurance & ERISA Attorneys has successfully handled ERISA disability claim appeals with all the major insurance companies. We also handle lawsuits for disability benefits.
Call (800) 969-0488 for a free consultation with one of our ERISA appeals attorneys.