How To Appeal A Denied Disability Claim

The Employee Retirement Income Security Act (ERISA) of 1974 is a federal law that governs the administration of employer-sponsored retirement and health benefit plans.

It also provides certain legal protections to those receiving disability benefits through their company’s plan. When an employee files a claim for disability benefits, the plan must provide specific information regarding its eligibility requirements and the appeals process.

If your employer has an ERISA-governed plan and you make a disability claim, the insurance carrier will typically require you to file an appeal within 180 days of receiving the denial letter.

If your claim is denied again after filing an appeal, then you may be able to pursue litigation in federal court.  This can be a complex and lengthy process, so it is important to make sure you have the right legal representation on your side.

The disability claims process can be confusing and frustrating. It is important to understand that the insurance company or government health benefits program has the ultimate authority to make decisions on your claim. As a result, it is quite common for denied appeals to occur. In addition, there are other complications that can arise such as delays in processing paperwork or errors in the calculation of benefits such as:

• Misinterpretation of policy provisions;
• Requests for additional medical records or proof of disability that aren’t properly documented;

• Failure to consider relevant medical evidence;
• Improperly denying the claim based on certain criteria.

When considering a disability claim in Florida, it is important to be aware of why certain claims may be denied:

For a disability claim to be approved, you must provide sufficient medical evidence that establishes your disability. Be sure to submit all necessary medical records to the insurance company yourself and don’t depend on the insurance company to get your records. Also, submit any other supporting documents to make the most robust case possible.

1. Contact an experienced disability attorney who can help you understand your rights and guide you through the appeals process.
2. Request a copy of your denial letter from the insurance company or government health benefits program so that you can review the reasons for your denial.

When reviewing the denial letter, pay close attention to any references to policy provisions or legal standards that were not met for your claim to be approved like applicable time limits or medical evidence requirements.

This will give you a better understanding of what is needed for you to be successful in appealing the decision.

We understand that you may be frustrated with the denial of your claim and want to take action right away. However, as mentioned earlier, the insurance company has ultimate authority over your case.

As a result, contacting them directly about a denied disability claim may not always be the most effective route in resolving the issue.

Instead, you should consider hiring a disability attorney with experience in the appeals process who can handle your claim on your behalf.

Appealing a claim on your own is not an easy process no matter what the insurance company tells you and you may ultimately end up doing more harm than good appealing on your own.

If you believe that your disability claim has been wrongfully denied, there are a couple of steps you can take to determine if this is the case.

The first step to take is to talk to an experienced ERISA attorney. An attorney can help you better understand your rights and advise you on the best approach for appealing the denial of your claim. An experienced ERISA attorney has seen countless disability claims and denial letters, so they can help you determine if your case is being handled correctly or not.

While it is possible to file an appeal on your own, the appeals process can be complicated and confusing. The insurance company wants you to file an appeal on your own as most people end up not submitting the proper evidence and hurting their case. Hiring a disability attorney experienced in ERISA appeals can make all the difference in getting your claim approved. An attorney will ensure that all required paperwork is properly filled out and submitted and provide legal counsel throughout the process.

If your appeal is unsuccessful, you still have options.

It depends. Some policies make you file two appeals before you can file suit. Once the final appeal is denied, you can still file a lawsuit against the insurance company if you believe your disability claim appeal was wrongfully denied.