A Chicago ERISA Attorney Can Help You Through the ERISA Appeals Process
If you are a disability insurance insured, and the plan is sponsored by your private employer, then the benefits claim is very likely governed by the set of regulations established by the Employee Retirement Income Security Act (ERISA). ERISA imposes a number of unique requirements, including an extensive internal review stage (the “administrative appeals” process) that precedes traditional litigation. As such, ERISA disputes can be somewhat complicated.
Though many first-time claimants believe that the administrative appeals process is simple and unimportant, that could not be further from the truth — the administrative appeals process gives the insured-claimant the opportunity to have their denial decision fully and fairly reviewed prior to litigation. Securing a favorable benefits decision pursuant to the ERISA appeals process is certainly possible, but you’ll have to be thorough in gathering the necessary evidence to support your claim.
We, therefore, encourage you to get in touch with an experienced Chicago ERISA attorney before you continue with the administrative appeals process.
Basics of the Administrative Appeals Process
Under ERISA, the administrative appeals process does not trigger until you have received the letter of denial for your submitted benefits claim. It’s worth noting that you cannot avoid the administrative appeals process — in fact, ERISA regulation requires that you fully exhaust your administrative remedies before you are allowed to bring a civil action against the insurer (and/or the plan administrator).
There are a number of deadlines to keep in mind. From the date of the denial letter, you have close to six months (e.g. 180 days) to file for an administrative appeal and supporting documentation, and the insurer then has 90 days to re-review your claim and the rest of the documents contained in their claim file and make a decision.
ERISA disability benefits claims impose a stricter deadline of just 45 days on the insurer, though they are entitled to request two 30-day extension periods if there is sufficient reason to justify the request.
Every plan is different. With some ERISA disability benefits plans, you may have to seek a second appeal before you have fully exhausted your administrative remedies. It’s important to consult with a Chicago ERISA law firm for details on the specific procedures that you must satisfy.
In the event that the administrative appeals process leads to an affirmation of the denial of benefits decision, you may file a lawsuit and seek recovery in court.
Developing a Comprehensive Claim File is Extremely Important
Your claim file encompasses all evidence — documentary and otherwise — that is relevant to the benefits claim collected, reviewed, and created by the insurance company. In the disability context, relevant evidence for inclusion in the claim file may be:
- Medical records
- Expert reports
- Research reports
- Claim-related communication
- Vocational and functional evaluations
- Personal testimony
- Photographic and video evidence
- Letters of support (from your physician and other healthcare providers)
- And more
Successful resolution of an ERISA disability dispute generally requires that the claim file be comprehensive. If the administrative appeals process does not lead to a favorable outcome, and you are forced to litigate your claim in court, you are frequently unable to have the court consider evidence outside of that claim file — you will be entirely reliant on whatever has been added to the insurer’s claim file pre-litigation.
Contact an Experienced Chicago ERISA Attorney for Help With Your Administrative Appeal Process
Bryant Legal Group, P.C. is a boutique litigation firm with attorneys who have decades of experience advocating on behalf of insureds in disputes against their insurers, including those that involve ERISA. We understand the complexities typical of ERISA administrative appeals, and the importance of the claim file — not only for securing a “win” during the internal review process, but also for the eventual lawsuit, if an early resolution to the dispute is not reached.
If you are an ERISA insured, and find yourself with a denied ERISA disability claim, call an experienced Chicago attorney here at Bryant Legal Group, P.C. at (312) 561-3010 or submit an online form to schedule a consultation today. We look forward to assisting you through every step of the ERISA dispute process, including the critical “administrative appeals” phase.