Synopsis: If your claim has been denied through ERISA group policy the most important part now is the actually filing of your 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.
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.
Information supplied courtesy of the experts at diattorney.com who specialize in disability insurance claims.