If you worked for a private company in the U.S., you are probably covered by the Employment Retirement Income Security Act (ERISA), a federal law passed in 1974 that sets minimum standards for most private industry pension and health plans to provide protection for individuals who participate in these plans.
Have you filed a claim for ERISA disability benefits and had your claim denied? If your ERISA disability claim has been denied by your insurer, you will probably be able to appeal the decision.
The Difficult ERISA Disability Benefits Appeal Process
According to the law, every employee benefit plan must afford a reasonable opportunity to any participant whose claim for benefits has been denied for a full and fair review.
To file an appeal, you will have to follow the appeal procedure as written in your insurance policy.
As soon as possible after your claim has been denied, you should enlist the services of an experienced ERISA disability benefits attorney to assist and represent you during the appeals process.
You will be required to follow strict rules and deadlines to successfully appeal a denial, and any misstep along the way can mean losing out on your benefits. Houston disability benefits lawyer M. Stanley Whitehead has the knowledge and expertise to guide you through every step of the appeals process, as well as litigating the claim in court if necessary.
Deadlines and Evidence in an ERISA Appeal
There are strict deadlines in the ERISA long term disability appeal process, and the amount of time you have to file an appeal is limited. Your benefits policy will tell what the deadlines are for your insurer; some policies have a 60 days deadline, but most policies allow you 180 days to appeal the denial. Some even allow two appeals. Missing a deadline usually means your appeal will be denied.
During an appeal, you must submit factual, medical, legal and vocational evidence to show how and why you are disabled, unable to work, and entitled to benefits under your company’s policy.
In order to build a solid and effective ERISA appeal case, our attorneys will work closely with you, your treating physicians and other relevant professionals to ensure that the information included in the appeal contains the necessary details to demonstrate the severity of your impairment and the impact it will have upon their life. We will also review all the required documentation to make sure it is properly and completely filled out, with no errors or omissions.
You Can File a Lawsuit after You’ve Been Denied Benefits
If the insurance company denies your appeal, our next step will be to initiate a lawsuit by filing a complaint with the United States District Court. In a case appealing the denial of ERISA benefits, the judge alone decides the case – there are no juries.
The judge will make his decision based on the evidence in the administrative record. The administrative record contains the evidence and other materials obtained by the insurance company before your suit was filed. In many cases, this is the only evidence that will be admitted into the trial.
If you prevail in court, the judge will order your benefits reinstated. You may also ask the judge to award attorney’s fees. If the insurance company prevails, the case is over, unless you wish to appeal the judge’s decision to a federal circuit court of appeals.
Get Help Today from a Respected Houston Disability Benefits Attorney
Time is not on your side when you decide to an ERISA long term disability appeal. If the insurance company has denied your claim, it is important to seek immediate legal help.
M. Stanley Whitehead is highly experienced with the complexities of Federal ERISA law. Don’t lose your benefits because of an avoidable error. Contact us online or call (713) 993-7311 to schedule a free initial consultation to discuss your case. The Law Offices of M. Stanley Whitehead are based in Houston, but we serve disabled workers and veterans all over the U.S.
