ERISA long-term disability benefits are not as easy to be approved for as you think. Even though these benefits are governed by federal law, the insurance company has quite a bit of room to operate. This means that they can deny claims and force you to fight for your disability. These are the rules of the game that you must play by when you want benefits, and you should have the help of a Mt. Holly long-term disability attorney.
Filing Your Claim for ERISA Long-Term Disability Benefits
Your process begins when you file your initial application for benefits. Presumably, you would include all the documentation that supports your claim, including:
- Medical diagnosis and prognosis
- Vocational reports
- Physician’s statement
- Your statement
- Other documentation that supports your claim
One of the common reasons for denial is that the insurance company does not believe that you are disabled. They may even resort to sneaky tactics such as hiring someone to follow you to get evidence that could dispute your claim. All of this is to say that they can deny your claim for the slightest of reasons.
The Administrative Appeals Process
You have rights when your claim is denied. While you cannot sue the information company for wrongfully denying your claim, you can file an administrative appeal. In fact, ERISA expects you to fully go through this process before you could even go to court. Some people may hesitate to file an appeal with the same company that turned down their initial claim. However, you have no choice. This is the process that the law requires. ERISA does not really do claimants any favors. If you did not already have a lawyer, the appeals process is when you need to hire one. The key is to put together a file with extensive documentation that supports your claim. Even if the insurance company still will not approve your benefits, this will help you at the next step of the process. Insurance companies actually fully consider the record at appeal. Many claimants are successful during this process, perhaps because the extensive appeal file clears up misunderstandings or provides something that was missing. If your appeal is unsuccessful, you still have the ability to take your case to court. The insurance company does not have the final say. However, you will not get a trial or hearing where you get to introduce evidence. The judge will take the file from your administrative appeal and review it to see if the insurance company made a mistake. Of course, your attorney will get a chance to explain in writing why you are entitled to benefits, but you are not able to add new evidence to your file. This is another reason why you need an experienced attorney who is intimately familiar with the appeals process.
Consult with a Long-Term Disability Attorneys in Mt. Holly
The attorneys at The Garner Firm fight for their clients when they are up against the difficulties that insurance companies cause them. We do not let them off easy when they deny you benefits. Contact us today to find out how we can help you in your case.