ERISA Administrative Appeals Are Mandatory Before Filing a Lawsuit
If your long-term disability policy is governed by Employee Retirement Income Security Act of 1974 (“ERISA”), you need to understand that ERISA claims are different. Under ERISA, there are certain things you must do before you are entitled to file a lawsuit to recover benefits that were wrongfully denied or terminated.
You can learn more about all these differences by downloading our free ERISA disability guide, Danger: Proceed At Your Own Risk.
However, one key difference is this: before filing a lawsuit in court, ERISA requires you to exhaust all "administrative remedies." This means you must file an administrative appeal with the insurance company before filing pursuing your case in court.
ERISA Gives Insurance Companies Broad Discretion to Deny Claims
The administrative appeal process gives the insurance company the opportunity to take another look at your ERISA benefits claim and to reach a different decision if it believes the facts warrant it. However, ERISA also gives broad (although not unlimited) discretion to the insurance company in reaching a decision on whether to deny or terminate benefits.
ERISA Long Term Disability Appeals Are Complicated
The administrative appeals process is an important opportunity for you to provider any and all supporting documentation and evidence for your claim. It is critical that you gather and submit every possible piece of information that supports your disability claim and to address any inaccuracies. You will not be able to submit anything further after the appeals process has ended. ERISA bars you from adding new information beyond the claims file later.
If you file a lawsuit prior to filing an administrative appeal on an ERISA disability benefits claim, two things are very likely to happen. First, the court will dismiss your claim based on your failure to follow the requirements of ERISA. Second, by the time your case is dismissed, the deadline to file an administrative appeal may have passed.
Remember, you only have 180 days from the date of denial to file an administrative appeal. These deadlines are firm. If you fail to pursue your appeal within this timeframe, you will lose your right to file a lawsuit or recover any benefits - even if you have a valid claim that should otherwise be paid under the law.
Contact an Experienced ERISA Long-Term Disability Lawyer
ERISA claims and appeals are difficult to win, and the rules and procedures are complex and unforgiving. The stakes are high in these cases, and no one should try to go it alone. If you want to learn more about why, download our free book on long-term disability appeals, Danger: Proceed at Your Own Risk. This guide lays out the exact steps you should take in handling an ERISA LTD appeal.
Of course, we recommend that, since these claims are so complicated, that you consult with an attorney who is experienced in ERISA before filing your appeal. Our long-term disability attorney in Kansas City will review your denial letter for FREE, and there is no obligation to hire our firm. We can help answer your questions and provide guidance on what to do next, so you protect your right to appeal and have the right strategy in place to get your benefits.
If you have questions about long-term disability cases, call our Kansas City long-term disability lawyer today at 816-203-0143, or fill out the form below. We'd be honored to help.