The answer to this question is simply: if your claim is governed by ERISA, obtain legal representation.
Let me explain to you why it is so very important to get an attorney involved, and why it is important to do so immediately. If your claim is governed by ERISA, here is the procedural framework you are facing:
- You have 180 days to appeal from the date of receipt of the denial/termination letter;
- Your insurer has 45 days to respond to your appeal;
- Your insurer is allowed one additional 45-day extension;
If your insurer upholds the termination/denial of benefits, your only recourse is to file suit in federal district court.