Before you can appeal an ERISA long-term disability denial, you must exhaust all of your administrative appeals. That means you must file an administrative appeal with your insurance company before you can pursue a court case. If your denial is upheld on appeal, you can then proceed with a lawsuit.
Gather evidence in support of your LTD
Start by reading your denial letter and understanding exactly why your claim was denied. Depending on the reason, you will need evidence to support your appeal. For instance, it is not uncommon for an insurer to claim you are capable of working at another job. A vocational expert may prove necessary to argue that this option is not realistic at your level of disability.
Request a copy of your file and a copy of your disability insurance policy
Submit a request in writing for your claim file from the long-time disability insurer. Under ERISA rules, the insurance company must send you a free copy of your file. A file review is needed to ascertain why your claim was denied. You can also determine what additional documentation is required. One caveat: Your file is likely to be quite large. It is not a matter of several dozen pages but several hundred or even thousands of pages.
You will also need a copy of your disability insurance policy. It is vital to know how your policy defines disability and whether you meet that criteria. You must meet the criteria in order to overturn the denial decision.
Don’t forfeit future legal rights
Because ERISA does not permit the submission of additional information after your administrative appeal, it is imperative that all supporting information is included. Whether that information involves a physician’s statement or documentation from other experts–even reports from family members regarding your condition–you must include it as part of the appeal or probably lose the right to submit such crucial information later on. In other words, leave no stone unturned.
ERISA rules are complicated, which is why you need a long-term disability attorney with experience in these appeals. An ERISA appeals denial is not something a layperson should attempt on their own. Making errors that may harm your claim is far too easy to do.