When you are applying for ERISA disability benefits, the insurance company that would pay out the claim has the initial say about whether you are entitled to benefits. This creates a situation where many initial benefit claims are denied, often wrongfully. This is why you need a West Chester long term disability lawyer for your case. After your claim is denied, the first thing to do is take a deep breath and focus on the appeals process ahead of you. If you do not already have long-term disability lawyers on your side, now is the time to hire one. The appeals process is complicated, and the insurance company brings its own legal firepower to the table.
You Need to File an Administrative Appeal of a Benefit Denial
The initial step of the process is appealing your denial to the insurance company itself. If they rejected your claim because there was a misunderstanding or incomplete information, now is the time when you can clear up the issue and show that you qualify forbenefits. Sometimes, you can qualify for benefits by better explaining your side of the story to the insurance company. However, the insurance company is far from on your side. They are paying attention to their own bottom line, and the more claims they pay, the less money they make. They are required to give you a reason for the denial. Beyond that, they tend to be sticklers for details. Insurance companies might even hire people to observe you and talk to your friends so that they can have further ammunition to deny your claim.
How to Appeal a Benefit Denial
When you are filing an long-term disability appeal, you should treat it very carefully. In many cases, after the internal appeal stage, you will be unable to add much if any information to your file if your case ends up in front of a judge. You should submit all relevant information, including:
- Your complete medical records and diagnosis, along with explanatory statements from your physicians;
- Your own personal statements;
- Statements from your family and friends who have observed your condition;
- Reports from vocational experts; and
- Information about the duties of the occupation(s) that you cannot perform
If your internal appeal to the insurance company is not successful, you still have legal options. ERISA gives you the right to file a lawsuit against the insurer after you have exhausted all administrative appeals. A judge will consider the record of your appeal to the insurance company and decide whether the insurance company wrongfully denied your benefits. Generally, your attorney will need to work with the exact record that the insurance company considered to persuade the judge.
Contact a West Chester Long Term Disability Attorney
If the insurance company does not approve your claim, you need legal help to contest their denial. The Garner Firm has experienced attorneys with a track record of assisting benefit applicants who have been unfairly denied benefits. Contact us today to schedule your free consultation so that we can discuss a legal strategy for getting you disability benefits.