Appealing ERISA Long Term Disability Insurance Claim Denials

J.P. Gonzalez-Sirgo
Founder of J.P. Gonzalez-Sirgo, P.A.

The process for appealing a long term disability insurance claim regulated by the Employee Retirement Income Security Act of 1974 (ERISA) is different than disputing a long term disability insurance claim denial based on an insurance policy purchased on an individual basis.  You have the right to sue on an ERISA denied long term disability insurance claim, but you will first need to exhaust the internal administrative appeals process established by the insurance company.  If you fail to exhaust the internal appeals process, it can negatively impact your lawsuit.

There are basically two steps in handling ERISA long term disability insurance claims, which are the initial filing of your claim and the review by the insurer.  If you are denied long term disability insurance benefits you have two options: either you can accept the decision or you can appeal for another internal review within the insurance company.  Each step has deadlines that are specified in your insurance policy and denial letter.  If you do not adhere to these deadlines, you may lose your ability to recover on the insurance policy.

If your long term disability insurance claim is denied, you will receive a denial letter from the claims reviewer.  In the denial letter, the insurer must provide the reason for denial, reference the specific policy provision used to make the decision, explain the process to have the denied claim reviewed and advise you on your legal rights to file a lawsuit under ERISA.  In addition, the claims reviewer must either provide or offer to provide any internal rules or other criteria used to make the claims decision.

It is important to properly prepare for the appeals process as you may only have one chance to make your case.  You are also not generally allowed to add evidence after the appeals process is completed.   To help your chances of success, you need to ensure that you thoroughly prepare your appeal and all exhibits in support of your appeal.

Once you submit your appeal, the appeals committee is required to give your file a complete and fair review.  You should receive the insurance company's decision in writing within 45 days of filing your appeal.

If you are not satisfied with the results of your long term disability insurance claims appeal, you can pursue a lawsuit under ERISA.  An experienced long term disability insurance claims attorney can help prepare your case for court.

You can reach Miami Insurance Claims Lawyer J.P. Gonzalez-Sirgo by dialing his direct number at (786) 272-5841, calling the main office at (305) 461-1095, or Toll Free at 1 (866) 71-CLAIM or email Attorney Gonzalez-Sirgo directly at [email protected].

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