How to Win Long-Term Disability ERISA Appeal
Congress passed the Employee Retirement Income Security Act (ERISA) to standardize the insurance benefits provided to private-sector employees. Employees participating in ERISA-covered plans have the right to appeal denials of benefits. This includes all denials of long-term disability (LTD) claims. However, ERISA is a complicated law, and filing an ERISA appeal is far from easy. Knowing just a few simple tips and tricks might help you guarantee your future financial security.Â
If you are considering filing an LTD ERISA appeal, then you’ll want to read our advice below. To obtain a unique evaluation of your case, you should immediately contact John Robert Peace, PA. He is an experienced ERISA attorney who can help.
The Four Keys to Winning a Long-Term Disability ERISA Appeal
Winning a disability ERISA appeal is not merely a matter of luck or chance. Instead, knowing how to win an ERISA disability appeal comes down to following a few tried and true strategies.
Key #1: Request and Review a Complete Copy of Your ERISA Disability Insurance Policy
Understanding your LTD policy is the first and best way to prepare yourself for a successful ERISA appeal. It’s especially important to have a copy of the full policy, not just a plan summary or a website page. Your LTD insurance policy has vital information hidden in seemingly ordinary provisions. Attention to detail is critical here. Specific pieces of data you should look for in your policy include the following items.
Policy definitions
When filing an ERISA appeal, you cannot trust that specific words have their ordinary definitions. Instead, your policy will state in unambiguous terms what various terms mean. Understanding these definitions will help you avoid unpleasant surprises.
Limitations
Most LTD insurance policies place limitations on certain conditions. The most common limitation is on mental or nervous conditions, which can include a shockingly vast array of health issues.
Exclusions
Aside from limitations, LTD plans refuse to cover certain disability causes. Common exclusions include injuries caused by aircraft, suicide attempts, pregnancy, and acts of war.
Many insurance companies employ vague and broad language in their policies. While various states have laws prohibiting such language, insurance companies don’t always follow these laws. If you encounter language in your policy that is too confusing, contact a qualified ERISA attorney. They will be able to decipher your policy’s language and give you guidance on how to move forward.
Key #2: Discover the Exact Reasons Behind the Denial
Once you have an understanding of your policy, review the denial letter you received from your insurance carrier. Generally, the letter will state the exact cause of the denial. Knowing the cause is vital to winning your appeal. In some cases, the cause of the denial might be a simple bureaucratic issue. Examples include illegible handwriting on a medical note or a missing signature on an application.
On the other hand, your insurance carrier may have denied your claim because your condition fell under one of your policy’s limitations or exclusions. Whatever the case, you need to know the cause of the denial so you can properly address that issue when you submit your appeal.
Key #3: Obtain a Complete Copy of Your Disability Claim File
Your disability claim file includes all the evidence your insurance carrier reviewed when evaluating your LTD claim. ERISA guarantees all insurance claimants the right to request a copy of this file to help them understand why the carrier rejected their claim.
Having the file is helpful primarily for two reasons. First, it shows you what you need to refute to win your appeal. Second, it confirms that your insurance carrier had all the information you provided. If you find that your disability claim file is missing a critical medical document, then you may prevail in your ERISA appeal simply by including a copy of that missing document.
Key #4: Work Closely with Your Doctors and Independent Medical Reviewers
The foundation for any successful ERISA appeal is quality documentation from your medical providers. Before and during your ERISA appeal, continue visiting with your regular doctor and other care providers. This helps ensure you have a strong amount of supporting medical evidence. Indeed, the more regular visits you have with your doctor, the more persuasive your documentation will be.
Insurance companies cannot simply ignore well-documented medical conditions. However, if your insurance company downplays your physician’s medical documentation, consider contacting a third-party doctor for an additional examination. If their testimony agrees with your own physician’s findings, that will help ensure you have a successful ERISA appeal.
Two Common Mistakes You Should Avoid to Secure a Favorable ERISA Appeal
There are many rookie mistakes that insurance claimants make when filing an LTD ERISA appeal, but these two are especially common.
Mistake #1: Failing to File Your ERISA Appeal on Time
Filing an ERISA appeal is exhausting. On top of that, most insurance claimants have to manage their disability and struggle with money issues while preparing to file their appeals. Given these difficulties, claimants often wait until the last minute to begin their appeal. This causes them to either miss the deadline entirely or submit a rushed, slipshod appeal. Consequently, it’s best to start preparing your appeal right after you receive a denial letter.
Mistake #2: Not Hiring an ERISA Attorney
ERISA appeals are incredibly complicated. Thus, you should consult with an experienced attorney if you truly want to maximize your chances of a successful ERISA appeal. ERISA lawyer can help your appeal by:
- Evaluating whether your claim has missing information,
- Collecting new evidence that supports your arguments on appeal,
- Helping to assemble and file your appeal, and
- Negotiating with your insurance company to obtain a favorable settlement.
Any one of these actions will help ensure your appeal has the best outcome possible.
Want to Learn More About How to Win a Long-Term Disability ERISA Appeal? Contact John Peace at the Peace Law Firm.
Knowing some of the key strategies for a successful appeal is just the first step in your battle for justice. The next step is to get qualified legal assistance. A qualified ERISA lawyer can lighten your workload, improve your appeal, and help you obtain the benefits you need.
Since 2002, John Peace and the Peace Law Firm have helped countless clients obtain their rightful LTD benefits. We have decades of experience assisting clients with ERISA issues, so we know what it takes to turn the tables on insurance companies. Call us today or reach out to us online to arrange your free initial consultation.
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