Issues That Arise During an ERISA Appeal: Things To Do Before You Hire an Attorney

If you have a long term disability claim through a policy provided by your employer, ERISA most likely governs that claim. As such, if your claim is denied and you have to pursue your benefits, there are very specific rules and regulations about how – and sometimes whether – you will be able to provide evidence of your disability to the insurer. Also, the quality of the evidence matters very much. This blog will give you some pointers on what to gather before you hire an ERISA attorney to assist you or even prepare your own appeal.

(1) Request your claim file – if your claim has been denied, you should request a complete copy of your claim file from your insurer. This will help you or your attorneys ascertain whether you have a case, along with the quality of the evidence you will want to obtain in order to rebut the reasons for the denial.

(2) If you don’t already have them, make sure you request copies of all Plan documents from your employer.

(3) Obtain copies of your medical records – you should have copies of all of your relevant medical records to help determine whether you have sufficient medical evidence of disability.

(4) Discuss support with your treating physician(s) – you should have a conversation with your treating physicians about whether and to what extent they are willing to assist you with this claim. Not only do you need to make sure you send the insurance company all of your medical records, it is always a good idea to try and get letters of support from your doctors as well. Even better would be to also get some written opinion from your doctors about the reports and conclusions generated by the insurance company’s reviewing physician(s).

(5) Know that time is of the essence – if your appeal is governed by ERISA, you will have a deadline by which you must appeal the denial, or your rights will be forever lost. The longer you delay preparing an appeal or in hiring an ERISA attorney to help you, the less time you will have to properly prepare your appeal.

If your disability claim has been denied, and you decide you need legal help, contact Kantor & Kantor for a no-cost consultation.

We understand and we can help. (877) 783-8686

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