Having to deal with an ERISA disability claim can often feel like an uphill battle. While it is wholly possible that some of these claims will go through without any issues, there’s also a possibility that your claim will be denied. If this occurs, you’ll need to review the denial notice completely because it will contain vital information.
At a minimum, the denial notice must include an explanation of why the claim wasn’t approved. This should be detailed and it must note why the plan didn’t accept the views of vocational experts or medical professionals if necessary. There must also be information about what aspects of the policy are the basis for the denial.
The letter should also contain information about the appeals process. This must include the time limits that apply, which must be at least 180 days to file the appeal. You should also be notified about your right to pursue legal action in court if the appeal is denied.
When you file an appeal, someone new has to review the file. This person must consult with medical professionals. The person must not be the subordinate of the person who made the initial decision. The denial and reason for it must not be considered by the person who’s reviewing the case.
There are time limits that apply to the decision-making process, but it is possible that the plan will qualify for an extension that gives the reviewer more time. All of this can draw things out considerably, so it’s typically better if you get your appeal filed sooner. Working with an experienced advocate who is familiar with the process is also beneficial.