If you recently applied for ERISA disability insurance and the company denied your claim, you may be frustrated. Perhaps you are wondering what to do next. The first thing you should know is that you have a limited amount of time to appeal their decision. You must act quickly. Although each policy is slightly different, here are the steps you must take to appeal your ERISA disability claim denial:
- Read your denial thoroughly. If the plan administrator denies your claim, they must give you a written notice regarding the reason, and the notice must be understandable. Only after you understand the reason for the denial can you hope to respond effectively. You may need legal assistance to do this.
- File your first appeal. The law requires your plan to allow at least one opportunity for you to respond to your denial. You will have at least 180 days to file your appeal, but you must gather a considerable amount of information in that time. You should gather the following information:
- An appeal letter of 50 to 100 pages
- Letter from your doctor
- Articles about your medical condition
- New information in your medical records
- Allegations regarding the insurance company’s unfair denial
- The administrator makes a decision. The administrator has 45 days to consider the appeal in a disability case, but often requests an extension and usually denies the appeal.
- File your second appeal. Your plan may allow for more than one appeal. If the administrator denies your first appeal, you may need to file a second appeal. Your timeframe will depend upon the policy, so pay close attention to when you must file your appeal.
- File a lawsuit. Once the administrator has denied all of your appeals, you have exhausted your administrative remedies. You may now file a lawsuit in court. All the work you did for your appeal will be very important at this stage, since your evidence in court may be limited to the evidence you submitted to the company administrator during the appeal process.
Even if your company’s administrator denies your ERISA appeal, the appeal process is still an important step toward fighting for the benefits you deserve.