Why Your ERISA Appeal Is So Important

In a previous blog, we discussed the steps you need to take if you have a long term disability claim through a policy provided by your employer, before you hire an attorney. This blog will piggy back on that one, focusing on why the appeal itself is so important and more, why the quality of the evidence you submit during that appeal will make or break your claim.

Under the federal regulations governing ERISA claims, and the cases that have interpreted those regulations, your appeal is the only opportunity you will have to get evidence of your disability into your claim file. (There are a few exceptions to this general rule but for purposes of most cases, the appeal is it).

While you do have a right to litigate your claim once you have exhausted your administrative remedies under the plan, you do not have the right to testify, call witnesses or present new evidence to the judge. All the judge will see, if your claim goes that far, is the evidence that was submitted during your administrative appeal. Thus, the type and quality of the evidence you submit during your appeal is crucial to a successful claim.

Each case is different but some general guidelines about the type of evidence are:

(1) Submit copies of your medical records – these will help to provide objective proof of your disabling condition;
(2) Submit a letter of support from one or more of your treating physicians – your doctor can best describe your symptoms and their impact on your ability to perform the duties of your own occupation;
(3) Submit objective measures of your condition – depending on the type of disabling condition you have – tests like Functional Capacity Evaluations, X-Rays, MRI’s Neuropsychological Examinations and Vocational Assessments also help to support your claim.

We have posted a checklist on our website of things to consider when handling you own appeal. (Click on the word”checklist” to find it.)

If your disability claim has been denied, contact Kantor & Kantor for a no-cost consultation.

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

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