ERISA Disability Appeals – When Do You Get a Lawyer?

Long-term disability policies are confusing, even for some attorneys. It can be difficult to read between the lines, in fact, the language is meant to be hard to understand. Your employer’s long-term disability plan documents may say this:

“ERISA requires that you go through the Company’s administrative review process before pursuing any legal action challenging our claim administration. Submit your appeal to us within 180 days.”

Some folks think this means they couldn’t (or shouldn’t) use an attorney during the appeal process. That is simply not true. You should at least consult with a lawyer before crafting your long-term disability appeal. Many judges even say that ERISA is so confusing that without an ERISA attorney, many claimants are fighting an uphill battle.

Here’s what the plan documents should say:

“Get a lawyer to do your appeal. What we know but you don’t is that if you have to litigate your case later the only thing your lawyer is going to be able to use are the documents, reports, evidence and arguments that were in your appeal. Our claims adjusters are trained to not only deny claims but to “bullet-proof” the claim file so that even if you get a GREAT lawyer later, he/she doesn’t have any ammunition to use.”

We believe that these policies should be more transparent, and employers should notify their employees of the potential pitfalls in their long-term disability policy. If you are confused about the language in your long-term disability policy, do your research and find an attorney who has experience in long-term disability.

Contact our office today!

If you’ve received a denial letter from your employer’s insurer, give us a call and we’ll be happy to help.