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A denied long-term disability claim can be appealed. Disability denial appeals can be successfully handled by a lawyer who has experience appealing ERISA decisions. In most cases, group disability insurance policies are governed by the Federal Employee Retirement Income Security Act or ERISA.
An insurance company must give you an opportunity to appeal a denied disability claim under ERISA law. An appeal must be filed before you can file a lawsuit in court. The process is known as “exhausting administrative remedies.”
Long-term disability appeals must be in writing. In many cases, the appeal process is the last opportunity to prove your case. If your final appeal is denied, you will need to file a lawsuit. ERISA typically does not allow you to submit additional information once a lawsuit has been filed. Because of this, it is crucial that you submit all documentation and information supporting your disability – including all relevant medical information.
The appeals process requires you to seek help from your doctor – a letter explaining why you are unable to work should be written by your doctors at the very least. Depending on your medical condition, you may also need medical evaluations to prove your disability. Evaluations of functional capacity (FCE) and independent medical examinations (IME) are two types of medical evaluations. An IME, as an example, can reveal your physical limitations.
The only option left to you after exhausting all appeals is to file a lawsuit for disability benefits against your disability insurance provider. A case involving ERISA may prevent you and your doctors from giving testimony in court. Additionally, new medical information cannot be presented to the judge. During the long-term disability appeals process, you want to get as much support as you possibly can.
ERISA and Disability Insurance Companies
An appeal must be submitted within 180 days under ERISA. When you receive a disability denial letter from your disability insurance company, the 180-day period begins. There may also be a second appeal option available to you, but the second appeal may have to be filed in less than 180 days.
Your disability insurance company's denial letter should inform you of how much time you have to appeal, as well as why your claim was denied. An appeal decision must be made by the insurance company within 45 days. 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 and they may use your appeal to build a stronger case against you:
- Contact your doctors without your knowledge
- Do surveillance on you
- Send you for a medical examination with their own doctors
As part of the disability insurance process, the company's doctor will review your medical records and prepare a report about you. In the event that your appeal is denied, you are generally not allowed to submit any additional information to the court. In this case, you will have to rely on the information already in the disability insurance company's claim file – therefore, it is crucial that the appeal is handled correctly. ERISA lawyers experienced with ERISA should be contacted if you submit a disability insurance appeal. We have successfully appealed ERISA disability claims with all the major insurance companies. We can also handle disability benefit lawsuits in the event that it is needed.
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