If your Long-Term Disability is Denied you can file an Appeal
Author: Attorney Lonnie Roach
If your long term disability claim is denied, or if you have received a letter terminating your existing disability benefits, in many cases you can file a successful appeal. Not only does the appeal give you a chance to overturn the decision, but it is also a required step in order to preserve your right to file a lawsuit at a later date.
The long term disability appeal must be filed in accordance with the procedures and deadlines specified in your disability benefits plan.
If you don’t have your policy documents by now, you must obtain them quickly from the plan administrator. The most important thing to keep in mind is your deadline, because you are usually limited to a two- or three-month time period. You have to use this time very effectively.
The appeal stage is your last opportunity to make the administrative record as complete as possible.
This record is the legal term for all the evidence submitted to the insurance company. Once the appeal process is complete, the record is “set in stone.” Should you later file a lawsuit against your plan, the judge will only look at the existing administrative record. If you have not submitted enough supporting evidence, or the right type of evidence, you could lose your case regardless of how sick or disabled you may be.
The ERISA Long Term Disability Claim and Appeals Process
1. File a claim with your company-provided long term disability insurance.
- The disability insurance provider will investigate your claim.
- If your claim is denied, the provider must issue you a notification with explanation of the basis of their denial.
2. Appeal Adverse Decision
- If your claim is denied, you must file an Administrative Appeal. You should strongly consider contacting an experienced ERISA attorney to assist you in the appeal process.
- Submit a claim appeal in writing. This must be done within a specific time-frame or you risk permanently losing the chance to appeal!
- The appeal process is your final opportunity to add pertinent information to the claim record. This is significant in the event that the appeal is denied and you need to file a lawsuit. Your attorney can provide much needed guidance to you as to additional medical information that might strengthen the appeal, and future suit, should a lawsuit become necessary. You do not want to risk entering a lawsuit with an incomplete or weak claim record, which would severely decrease your chances of being awarded the disability compensation you deserve.
3. File a Lawsuit in Federal Court
- You can only take this step once you have gone through the entire appeals process.
- A Federal Judge will typically determine whether the ERISA plan’s decision was arbitrary and capricious.
4. A District Court decision can be appealed to the United States Circuit Court.
Once the court rules, the losing party can elect to appeal in select circumstances.
The LTD Appeal Process
Bemis, Roach & Reed has successfully handled cases against the following insurance companies:
For answers to other questions regarding ERISA please see our page ERISA Frequently Asked Questions or call toll free (866) 433-4979 for a free personal consultation.
Bemis, Roach & Reed has successfully represented long term disability clients throughout the state of Texas and can easily fight for claims across the state by working the cases remotely, via phone, fax and e-mail.
Author: Attorney Lonnie Roach has been practicing law for over 29 years. He is Superlawyers rated by Thomson Reuters and is Top AV Preeminent® and Client Champion rated by Martindale Hubbell. Through his extensive litigation Mr. Roach obtained board certifications from the Texas Board of Legal Specialization. Lonnie is admitted to practice in the United States District Court - all Texas Districts and the U.S. Court of Appeals, Fifth Circuit. Highly experienced in Long Term Disability denials and appeals governed by the “ERISA” Mr. Roach is a member of the Texas Trial Lawyers Association, Austin Bar Association, and is a past the director of the Capital Area Trial Lawyers Association (Director 1999-2005) Mr. Roach and all the members of Bemis, Roach & Reed have been active participants in the Travis County Lawyer referral service.
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