Why Hire a Disability Attorney for Your ERISA Appeal
Author: Disability Attorneys Dell & Schaefer
Published: 2010/09/16 - Updated: 2026/01/11
Publication Type: Informative
Category Topic: Claims - Related Publications
Page Content: Synopsis - Introduction - Main - Insights, Updates
Synopsis: This information comes from disability insurance attorneys who specialize in ERISA claims and explains the critical importance of professional legal representation when appealing denied disability benefits under employer group policies. The guidance is authoritative because it's written by practicing attorneys who handle these cases regularly and understand federal court procedures. People with disabilities who've had their insurance claims rejected need to know that the appeal process isn't just another chance to disagree - it creates the entire administrative record a federal judge will review if the case goes to litigation. Since judges in ERISA cases don't hear live testimony or consider evidence submitted after the appeal deadline, claimants have only one opportunity to build a complete case file, making experienced legal help valuable for anyone navigating these strict federal procedures and tight deadlines - Disabled World (DW).
Defining Employee Retirement Income Security Act (ERISA)
- Employee Retirement Income Security Act (ERISA)
ERISA, the Employee Retirement Income Security Act of 1974, is federal legislation that governs most employer-sponsored benefit plans in the United States, including pension plans, health insurance, and disability coverage. Congress passed this law to protect workers after several high-profile cases where employees lost their promised retirement benefits due to corporate mismanagement and fraud. The law sets minimum standards for these plans, requires detailed disclosure of plan information to participants, establishes fiduciary responsibilities for those who manage plan assets, and creates a uniform system of enforcement through federal courts rather than state courts. What makes ERISA particularly significant for people with disabilities is that it preempts state insurance laws, meaning workers who receive benefits through their employer face different rules and often fewer protections than those who buy individual policies. Under ERISA, claimants cannot sue for punitive damages, cannot demand a jury trial, and must exhaust the plan's internal appeal process before going to court - restrictions that have made these cases notoriously difficult to win without experienced legal representation.
Introduction
Why Should I Hire a Disability Attorney to Submit My ERISA Appeal?
After your claim has been denied through an ERISA group policy, the most important part of your claim at that time is the actually filing of your appeal. When you receive your denial letter, the denial letter often says, "If you disagree, you have 180 days to appeal our decision and tell us why." A lot of times we see an individual just write a letter, "I don't agree. I want you to reconsider," not realizing the ramifications of that and what the appeal really means.
That appeal is your chance; that's setting up your argument for any future litigation in the matter. If they deny it and it has to litigation, it goes before a judge, a federal judge. You have no jury, the judge won't hear any testimony; he's going to review what's in the administrative record.
Main Content
The administrative record is comprised of what the insurance company has in their claim file and what you submit as additional evidence in support of your claim in your appeal.
If your appeal isn't filled with the type of objective test the insurance company may say were lacking, or you don't supplement with additional records, maybe medical records were never sent to the insurance company for review unbeknown to you.
So in the event that that information isn't contained and presented in your appeal, after the insurance company makes its final determination, you could realistically have a heart attack three days later and that may never make it into the administrative record for the judge to consider. So you have to see it as a very small snippet in time.
That appeal, your whole claim, is only going to go up to that last determination.
It may be a year until you see a judge and it goes technically to trial. The judge won't consider anything for that year, so your only chance, your time to tell the judge your story or to really put in all the information you can is during that appeal. That's why it's so important to hire an attorney.
If your claim has been denied, I strongly, strongly advise that you contact our office; we can review your denial letter and your policy, and let you know what your options are and how we can help you.