We recently were asked to become involved in several long-term disability cases. These cases were governed by the federal law of ERISA because they were welfare benefit plans through an employer.
Unfortunately each of the claimant came to us after they have conducted their own “appeals” of the benefit denials. Their appeals have consisted of nothing more than writing simple letter saying “I appeal”. In one case a couple of additional doctor records were attached.
A review of the files indicated that the claimant probably would have qualified for benefits had a proper appeal been done. In both cases however there was nothing more that we could do.
- once you have exhausted your appeals your next up is to file lawsuits in federal court
- there are no trials in federal court. The court will simply review the record that was developed by you and the insurance company
- the insurance company has no incentive and no duty to go out and get records and to make your case for you
- you should never file an appeal that simply says “ I appeal”, an appeal usually consists of
- additional medical records
- additional medical testing that an experienced ERISA disability attorney can suggest. Remember, attorneys are not doctors but inexperienced ERISA disability attorney will know what “missing records” may likely impact the claim.
- additional medical narrative reports which specifically address the reasons given by the insurance cover me for the denial of the claim
- statements of friends and family about the claimant's condition and their impact upon her activities of daily living and her ability to perform the material do you suffer occupation
- medical literature
- argument based upon ERISA law as to why this claim should be approved
A federal judge in Florida once said that a disability claimant who does not use an attorney during the 180 day appeal. Often faces and “loaded deck” when they go into federal court.