We noted in a recent ERISA Law Center blog post an individual’s understandable urge to immediately take an insurer to court following a denial or termination of disability benefits. Doing so would seem to be “a natural course of action.”
Yet, it would be advisable to hold that thought. In fact, it would be an imperative pending, required additional action.
Here’s why: ERISA law mandates that any filing of a lawsuit based on a disability claim first be preceded by an administrative appeal to the insurer that issued an adverse decision (or, alternatively, to a third-party administrator).
A bottom-line observation regarding that duty: You as an aggrieved claimant might not want to do that, but you have no choice if you want to keep open the option of litigating your disability denial or termination in court.
What are a claimant’s chances of success in an appeal?
Good. Fair to middling. Compellingly slim.
All those outcomes are a possibility, although we realistically note that “many administrative employee benefit appeals are denied” owing to lack of any real downside for an insurer to reverse course.
A key point to underscore re an administrative appeal
What is actually vitally important concerning an appeal is the opportunity it provides a claimant to secure proven legal counsel with a demonstrated record of success in ERISA disability matters. The appeal process affords an opportunity for an experienced ERISA attorney to craft a comprehensive record of proofs concerning claim history that, if necessary, can be persuasively presented to a court.
Time is of the essence concerning an administrative appeal, and there is much to do for a proven and enterprising ERISA legal team focused on assembling an accurate and complete claim record.
We welcome contacts to the firm regarding any questions regarding ERISA administrative appeals and litigation.