Appealing a denied ERISA claim

On Behalf of | Jun 20, 2022 | Long-Term Disability/ERISA

Insurance companies do not always hold up their end of the deal when it’s time to pay out disability benefits. Too often, even valid claims are denied leaving the beneficiaries on their own in the face of a disabling condition.

When your disability claim under ERISA is denied, it is possible to appeal against the decision and start receiving your benefits. However, you have to follow due process when appealing the initial decision.

Below is what you should expect.

The appeal process explained

Usually, the insurer will explain why your claim was unsuccessful. These reasons vary, from mistakes in the paperwork to missing information in your documents. When appealing the decision, it is crucial to understand the reasons behind your denial and provide evidence to back your claim.

With ERISA, you should exhaust the internal appeal avenues under your plan first before exploring other options. If your appeal is unsuccessful, you can file a lawsuit against the insurer or employer. Here, a judge will hear and determine the matter before issuing a final decision.

You don’t have much time

Time is among the most important considerations you should have at the back of your mind if you are going to appeal a denied claim. The time you have varies, depending on the terms and conditions of your plan.

Going beyond the stipulated deadline could lead to a dismissal of your appeal, and you could end up missing out on the benefits.

Do you need help when appealing a denied claim?

Sometimes, the legal technicalities in the ERISA appeal process can stand between you and a successful outcome. In addition, you do not have many chances to appeal a denied claim.

Getting legal assistance is advisable to increase the chances that things conclude in your favor.