The ERISA Long Term Disability Claim and Appeals Process

• File a claim with your company-provided long term disability insurance.
• The disability insurance provider will investigate your claim.
• If your claim is denied, the provider must issue you a notification with explanation of the basis of their denial.
• Appeal Adverse Decision
• If your claim is denied, you must file an Administrative Appeal.  You should strongly consider contacting an experienced ERISA attorney to assist you in the appeal process.
• Submit a claim appeal in writing. This must be done within a specific time-frame or you risk permanently losing the chance to appeal!
• The appeal process is your final opportunity to add pertinent information to the claim record. This is significant in the event that the appeal is denied and you need to file a lawsuit. Your attorney can provide much needed guidance to you as to additional medical information that might strengthen the appeal, and future suit, should a lawsuit become necessary. You do not want to risk entering a lawsuit with an incomplete or weak claim record, which would severely decrease your chances of being awarded the disability compensation you deserve.
• File a Lawsuit in Federal Court
• You can only take this step once you have gone through the entire appeals process.
• A Federal Judge will typically determine whether the ERISA plan’s decision was arbitrary and capricious.
• A District Court decision can be appealed to the United States Circuit Court. Once the court rules, the losing party can elect to appeal in select circumstances.