Why You Can't Handle an ERISA Long-term Disability Appeal on Your Own
There are several reasons why you should not try to handle an ERISA long-term disability appeal on your own. These are the same reasons so few lawyers take ERISA long-term disability appeals. These cases are just different and can be difficult to win.
ERISA is known to be an "insurance-friendly" area of law that gives deference and discretion to the insurance company in their denial decision. ERISA's requirements for determining benefit eligibility, filing of administrative appeals, and litigating denials are also confusing and complex.
ERISA appeals are mandatory before filing a lawsuit in court. Your appeal must contain all evidence to support your right to benefits because you will not be able to supplement later in court.
A judge decides the case, not a jury, and the standard is not whether you are entitled to benefits under the policy. Instead, the judge only considers whether the insurance company made a reasonable decision to deny or terminate based the information it had at that time.
ERISA Gives You a Short Deadline to Appeal
On top of all that, there is an extremely short timeframe for disability claimants to file an administrative appeal: 180 days. The failure to file an administrative appeal on time will almost always kill your case. There's plenty of ERISA case law that supports this, and one more case was just added.
The First Circuit recently held that a benefits claimant (someone who claims benefits, like you) did not timely "exhaust her administrative remedies" under a long-term disability plan. Exhausting administrative remedies is legalese that simply means the claimant did not file an administrative appeal of the denial in a timely manner.
The Court noted that the ERISA plan had the standard 180-day time limit by which a claimant must submit an appeal and that this clock started to run on the date the claimant received notice of that the insurance company was going to terminate her long-term disability benefits, not the date benefits were actually terminated.
The claimant made plenty of legal argument why she should get an extension beyond the 180 day deadline. These arguments were all rejected by the Court. As a result, the disability claimant was out of luck. Even if she had a solid legal reason to have her long-term disability benefits reinstated, she was prohibited from even making that argument due to the failure to appeal in a timely manner.
The case is Fortier v. Hartford Life & Accident Ins. Co., No. 18-1752, 2019 WL 697989 (1st Cir. Feb. 20, 2019).
Contact Our ERISA Long-Term Disability Lawyer in Kansas City
ERISA appeals are difficult and complex. As the case above demonstrates, what seems like a small mistake can have dire consequences. Having your benefits terminated or denied can be stressful and overwhelming. You should not go it alone. We strongly recommend you at least consult with an experienced ERISA attorney.
At the very least, download our free disability appeal guide, Danger: Proceed at Your Own Risk, which is packed with helpful information on how to win back your benefits.
Few attorneys handle ERISA cases, and you should consult with one who is trained in this specific area. Our long-term disability ERISA attorney in Kansas City will review your denial letter for FREE. We can help answer your questions and guide you on what you should consider doing next to get your disability benefits.
If you have questions about long-term disability claims or appeals, please call our Kansas City long-term disability lawyer today at 816-203-0143, or fill out the form below. We would be excited to assist you.