What Happens When Your ERISA Appeal Is Denied?

Last updated on July 30, 2024

The federal Employee Benefits Security Administration (EBSA) has detailed specific rules for disability and life insurance benefits plan administrators. These rules instruct plan administrators on how to handle Employee Retirement Income Security Act (ERISA)-governed benefits claims and appeals. If you have applied for long-term or short-term disability or life insurance benefits and have been denied, consider the information included with the denial and prepare to file an appeal, if appropriate.

Many claimants who hope to appeal after a denial soon realize that they need advice. A lawyer with years of experience is a reliable source of information and guidance on how to appeal successfully. At Toledano Disability Law, you can find personalized advice on how to increase your chances of making a successful appeal.

Answering Your Questions About ERISA Appeals

The prospect of appealing a denied ERISA claim can be daunting. With so many unknowns, it can be hard to take the first step. Our ERISA appeals clients often come to our attorney with questions, the most common of which he’s complied and answered below.

How long does an ERISA appeal take?

Suppose you submitted a claim for ERISA benefits like short-term disability, long-term disability or life insurance benefits, which was denied. In that case, you have 180 days beginning on the date you received the decision to appeal it. Once you submit your appeal, you can expect to get a response within about 45 days.

How much does an ERISA appeal cost?

The cost of appealing an ERISA decision depends on the legal representation you have. To find out what it could cost in your situation, contact Toledano Disability Law for a free case evaluation. During this meeting, our lawyer, Reagan Toledano, will take the opportunity to learn about the particulars of your case. You will also have a chance to ask any questions you may have and learn how attorney Toledano’s services’ pricing structure works.

Is an ERISA appeal worth it?

Yes. If your initial ERISA claim has been denied, going through the appeals process is the only way to continue to pursue the benefits you need. Appeals can be intimidating, especially since the claim has been denied once already. However, help from a skilled and experienced attorney can make a big difference. With the right strategy, it is entirely possible to have a successful appeal.

What other types of employee benefits fall under ERISA?

Besides long-term disability benefits, ERISA’s rules may encompass claims for short-term disability, accidental death, health insurance and long-term care. Our lawyer has a deep record of experience and success on behalf of clients making claims for these and other covered employee benefits.

Can I initiate litigation before the ERISA appeal is complete?

Typically, you must exhaust your administrative remedies with your ERISA policy, which means that you must pursue at least one ERISA appeal to its completion before you can file a lawsuit. Some policies also mandate a second appeal before you can actively begin litigation. An attorney can help you better understand the rules that apply to your plan.

What happens if I miss the deadline to appeal an ERISA claim denial?

Missing the deadline to appeal an ERISA claim denial can have serious consequences. Failing to adhere to the ERISA appeals timeline may result in the loss of your right to challenge the denial. Seeking legal counsel promptly over an ERISA denial is essential to explore potential options and make certain that you stay within the applicable ERISA appeals timeline to protect your interests.

How can an attorney help in building a strong case for an ERISA appeal?

An experienced ERISA lawyer plays a pivotal role in building a strong case for an appeal. They can navigate complex regulations, gather necessary evidence, ensure compliance with the ERISA appeals timeline and present compelling arguments to support your claim. They can also look for inconsistencies and mistakes in your claim file involving your medical records, independent medical exams and more, increasing the likelihood of a favorable outcome. In addition, they can make certain that your claim has all the evidence it needs to prevail in court if litigation becomes necessary.

Can I work with an ERISA attorney who is not located in my geographic area?

Yes, you can work with an ERISA attorney regardless of their location. ERISA is a federal law, which means that lawyers who handle cases in this area can provide representation across state lines. Choosing a skilled attorney who has experience and knowledge in ERISA concerns is more critical than hiring them based on their physical location, as they can effectively navigate the ERISA appeals timeline and regulations regardless of geography.

Let Our Lawyer Assist You In Appealing

After you have applied for short-term or long-term disability benefits and have been denied, the next steps can be briefly described as follows.

1. If you decide to appeal, we must do so within 180 days.
2. Your appeal may include additional information or clarify aspects of your application that may not have confirmed your eligibility persuasively or explicitly enough.
3. Expect a response within 45 days. However, an insurance company may request an extension.
4. Normally, you must exhaust internal appeals opportunities through your benefit plan before you can initiate litigation.
5. If the appeal results in another denial, you have the right to initiate a lawsuit.

An ERISA lawyer can help you cut through complex documentation requirements and rules to get your initial claim filed correctly and in a timely way. If you then need to file an appeal, your attorney will be ready to represent you efficiently.

Attorney Toledano Can Help You Appeal A Denied Benefits Claim

Since 2005, our lawyer has been helping people overcome ERISA-governed benefits denials. He is available to help you plan and carry out an appeal after your initial claim has been denied.

Do not hesitate if you are wondering how to appeal a denial after applying for short-term or long-term disability benefits. Get answers to your questions and guidance on how to get ready to appeal. Call 877-281-4789 or inquire online. We serve clients nationwide.