If a claim for ERISA disability benefits is denied or terminated, the claimant’s next recourse is to submit an administrative appeal to the insurance company. An ERISA long-term disability claim cannot be taken to court until the administrative appeals process is first exhausted. If the appeal is denied and the case proceeds to litigation, ERISA constrains the scope of evidence that is heard at trial and also limits the available remedies. (For this reason, ERISA is favorable to the insurance companies since it does not contain strong disincentives for denying meritorious claims).
It is important to understand that, with rare exceptions, the evidence submitted on appeal is the only evidence that will be considered in litigation—in other words, once the insurance company makes a final decision on an appeal, the file for litigation becomes closed. New supporting evidence does not get added during litigation and no witnesses are called to the stand to testify. The judge makes a determination based on the legal briefs submitted by the attorneys on both sides and a hearing at which the attorneys present arguments and answer any questions the judge may have. This makes ERISA litigation is a very particular type of litigation governed by certain rules and limitations which make the process quite different from many other types of litigation such as personal injury.
For this reason, thoughtful preparation and submission of all relevant evidence for the administrative appeal is absolutely imperative. Appealing the denial of a disability claim is not just a matter of refuting the insurance companies’ reasoning for the decision or pointing out overlooked facts. Rather, it is the one opportunity to assemble the strongest possible body of evidence that can be presented in court if the appeal is denied.
In most cases, individuals can and should file their own initial claims for disability without the help of an attorney. Because the appeals stage is so crucial to ERISA disability cases, consulting with an attorney as soon as possible if your appeal is denied is strongly recommended. There is usually a 180-day time frame to submit an appeal. Collecting documentation for an appeal can take time so it is important to get started on the process as soon as possible. Failure to submit a timely appeal is likely to result in forfeiting your right to bring a lawsuit to contest the decision.
An experienced ERISA attorney can address problems with the insurance companies’ decision and help gather the evidence that matters most to maximize the chances of reversing an unfair denial of disability insurance benefits.
If your long-term disability claim has been denied and you want to speak with an experienced ERISA attorney, please call Kantor & Kantor for a free consultation at 800-446-7529 or use our online contact form. Please note that here at Kantor & Kantor, our clients never pay a penny out of pocket. We only get paid as a part of your settlement.