ERISA Experience You Can Rely On.

Improving your chances of a victorious ERISA appeal

On Behalf of | Sep 22, 2022 | Erisa

The news stunned you. Your employer’s insurance company denied your application for long-term disability benefits. You counted on those payments to help you through this medical condition, allowing you to pay your medical bills and support your family.

Now, you must appeal the insurance company’s adverse decision. You also want to improve your chances of winning that appeal.

Narratives, details and medical treatment

You assumed the Employee Retirement Income Security Act of 1974 (ERISA) protected you, but it has many complications. As a result, employers’ insurance companies and some benefit plan administrators take advantage of ERISA’s protections by denying claims.

You need complete evidence to support your claim. Here are some things you must consider during the appeals process:

  • Prepare a detailed and accurate description of your job duties: Sometimes, insurance companies make assumptions and overlook crucial details in haste, painting an inaccurate picture of what your job entails. Things get missed, and you need to correct these mistakes.
  • Provide a detailed narrative of your disabling ailment: Make sure that this includes doctor certification related to how your condition affects and interferes with everyday aspects of your life as well as how it hinders your ability to perform your job.
  • Submit additional medical records: These along with supporting statements provide additional support in your goal to obtain those benefits.
  • Continue receiving medical treatment: Regular treatment provides supporting evidence confirmed by medical providers. Such steps may persuade the insurance company to reverse its previous decision. An insurance company cannot ignore this evidence.
  • Know the terms of your policy and related laws: A knowledgeable patient is a prepared patient. Show the insurance company the reasons why your claim deserves to be paid by citing the policy terms and laws that support your claim.
  • Contact a skilled attorney in ERISA law: ERISA-related matters – including an appeal – are complicated. Having an experienced legal ally to help you navigate through this system is beneficial.

You may already have done these steps, but you may have overlooked certain details. In addition, the insurance company may have made a perfunctory review of your case. Take the necessary steps to start your appeal process as soon as possible.

Pursue, prepare and seek support

Pursuing an appeal is necessary. Submitting documentation to support your claim and get the insurance company to change its decision, is the ultimate goal. Submitting a thorough, detailed and supported appeal is the only wat to meet that goad.