ERISA Administrative Appeals Are Mandatory Before Filing Suit
Under the Employee Retirement Income Security Act of 1974 (“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. For example, 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.
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.
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 and your lawsuit is on file because 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.
You should consult with an attorney who is experienced in ERISA. 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 for a free, no obligation consultation.