Why it’s vital to have an attorney help with a disability appeal right away

On Behalf of | Nov 25, 2019 | ERISA Disability Benefits

If an insurance company denies your disability claim, that isn’t the end of the road. Many people know you can appeal the decision in hopes of receiving a different outcome.

What a lot of denied applicants don’t realize, however, is that the decisions they make during this first appeal can have significant repercussions down the line – threatening the effectiveness of a potential court case.

The basics of the appeals process

Most disability plans offered through employers must adhere to the Employee Retirement Income Security Act of 1974, a federal law more often referred to as ERISA. This law lays out certain procedural and informational requirements for benefits such as disability insurance. That includes guidelines regarding the appeals process.

Under ERISA, if your initial claim is denied and you want to appeal, you must first do so through the insurance plan’s internal process. If you are once again denied through the entirety of the internal appeals process, then you can consider bringing an action in federal court to challenge the insurance company’s decision.

What they don’t tell you is that the outcome of a future court case can depend, in large part, on your choices during the internal appeals process.

How an attorney can help

When a disability appeal goes to federal court, a judge will review the case to make a determination. There is a caveat. Generally a judge will only look at whatever information and documents you sent the insurance company as part of the internal appeal.

That means you cannot provide new evidence to strengthen your case. You are stuck with whatever you submitted to the insurance company months earlier. Whatever holes were in your case back then will remain.

This is one of the reasons it is vital to reach out to an attorney as soon as possible if you are thinking about appealing a denied disability claim. An attorney can help not only strengthen your first appeal to the insurance company – improving your odds of winning there – but can also plan ahead for a potential court hearing. This could include:

  • Requesting all necessary documents from the insurance company
  • Reading through the company’s explanation of its decision
  • Gathering evidence to address those concerns
  • Tailoring that new evidence not just for the insurance company, but also for a federal judge

If you do not contact an attorney until after you have exhausted the internal appeals process, very little of the important preparation work described above can be done. Fair or not, this is the reality denied applicants face. Hiring a lawyer who knows the ERISA appeals process and prepares for all situations can help increase your chances of winning.