The important thing to remember is to not give up. We’ve successfully represented clients across a spectrum of insurance claims. There’s a process you can follow, whether your employer provides your insurance or if it’s an individual policy.
If your disability benefits are due to be provided by your employer, federal law requires you to go through an administrative appeal before you can enter into a lawsuit.
Here’s what you should do if you find yourself in an ERISA-applicable situation.
1) Meet Your Deadlines
Read the denial letter in detail. It should clearly set out the reason for your denial. In some cases, your claim may be denied for a simple reason, like missing documentation. You can resolve the situation yourself by providing your employer or the insurance company with your relevant documentation to receive your long-term disability benefits. Whatever the denial is, you need to be mindful of deadlines. If you miss a deadline, the insurance provider may use it as a reason to dismiss your claim entirely. Staying ahead of your deadlines can put your appeal on the right foot.
2) Present All Relevant Evidence
As federal law requires you to exhaust all available administrative appeals, you want to gather as much favorable evidence as possible. Once you’ve exhausted these routes, your record is closed. This process means no new documentation can be submitted into evidence for the judge to review.
You want to use the administrative appeal to submit any relevant medical reports relating to your condition. Documentation could include your physician’s notes, surgical reports, and any emergency room records on your incident. It’s advisable to obtain a written opinion on your physical and mental wellbeing from your personal doctor, including the impact of the denial on your health.
If someone in your family has to take over caregiving duties, you can ask them to provide an impact statement to the insurance company. This letter will explain the wider impact of your accident and injury.
3) Speak to Your Lawyer
Insurance companies have been able to deny claimants their disability benefits because the general public is not familiar with the appeal process. Enlisting legal representation from a lawyer with experience in this field can significantly improve your chances of a positive outcome in your appeal. They can fully brief you on the implication of ERISA on your case, along with representing your case directly to the judge.
