Many ERISA claims result from a denial of a long-term disability claim. It’s where the most areas of dispute often arise. There may be a question as to whether somebody is disabled or how fully impaired they may be. If your disability claim is denied, you can and should appeal the denial of that claim. You have 180 days typically to appeal the denial of a long-term disability claim for an ERISA-sponsored or a risk-regulated employee benefit plan. If you have an individual disability insurance policy that you purchased on your own, not through your employer, you may have different rights as it relates to an appeal. But if you have a risk-regulated employee benefit plan, you have 180 days to appeal that denial. The appeal is typically submitted to the insurance company who first denied your claim, but not always. So it’s important that you understand who you should be submitting the appeal to and what the deadlines for submitting that appeal are.
In addition, it’s really important that you provide a comprehensive appeal. Oftentimes, people don’t realize the significance of appealing a denial of claims, and they send in a short letter that says, “Appeal. I’m disabled.” And perhaps they have their doctor send in a note saying, “The client is under my care and is totally disabled from work and can’t work.” That’s not sufficient. It’s really important that if you’re handling your appeal on your own, you provide a very detailed and thorough appeal, but it’s typically a better idea to hire an employee benefits attorney with experience appealing long-term disability claims.