By Scott E. Davis, Disability Attorney
The biggest frustration I have as a disability insurance lawyer is being contacted by an individual who needs help in an ERISA disability claim and has a good case- but it may be too late. ERISA is the acronym for the “Employee Retirement Income Security Act” which is a broad and complex federal law governing all employee benefits (To determine if your claim is governed by ERISA look at the last page or two of your denial letter and it will reference ERISA and your legal rights).
Disability insurance companies frequently tell you that ERISA provides for a “full and fair review of your claim and they explain the many “protections” it provides to you as an employee – but nothing is further from the truth.
Disability insurance companies frequently tell you that ERISA provides for a “full and fair review of your claim and they explain the many “protections” it provides to you as an employee – but nothing is further from the truth. Never forget that ERISA stands for “Everything Rotten Invented Since Adam” for many reasons including a number of bad anti-consumer Supreme Court decisions over the past decades that has turned ERISA into your disability insurance company’s best friend in denying your claim.
If your disability claim is denied, the insurance company will explain when (at the latest usually 180 days from the denial date) and how to appeal, which must be done or your claim is forever lost. However, the insurance company does not explain THE most important information you must know – consult with a knowledgeable ERISA disability attorney ASAP as soon as your claim is denied.
It is never too early to consult with me, but at the very latest, please call ONCE you receive any denial, particularly your first denial whether it be a short or long term disability claim.
Clients often consult with me early such as while they are still working and once they realize that due to their medical conditions, they need to file a claim a disability claim in the near future. Clients consult with me at this early stage because they are skeptical of disability insurance companies and they want to know their legal rights and what to expect once the file their claim. It is never too early to consult with me, but at the very latest, please call ONCE you receive any denial, particularly your first denial whether it be a short or long term disability claim.
All too often, people mistakenly believe the time to consult with an attorney is after they have gone through the entire appeal process with their disability insurance company and the only option at that point is to file a civil action lawsuit in federal court. People often tell me they either did not understand they could consult with an attorney at any time during the disability claim process or they just were not knowledgeable enough to understand that it is not ideal to call an attorney after you have exhausted all your levels of appeal.
Although you can and should consult with a knowledgeable disability attorney even if you have exhausted all your appeals, this is not ideal because of ERISA’s complexity and the scant protection it provides you and your family.
As a result, the strength of your claim and your ability to win and obtain disability in federal court is only as good as the evidence that was submitted during your appeal.
It is critical to understand you do have to go through the insurance company’s appeal process and obtain a final decision regarding your disability claim. However, what disability insurance companies know and you do not know, is that the appeal process is your only opportunity to submit medical, vocational, and lay witness evidence to prove that you are disabled and meet the definition of disability. Because federal courts will generally only review the Administrative Record (i.e. your claim file) that was before the insurance company when it made its final denial, after the final denial you will not be able to submit any new evidence to the judge and this is a tremendous disadvantage to you. As a result, the strength of your claim and your ability to win and obtain disability in federal court is only as good as the evidence that was submitted during your appeal.
The fact that your claim file closes once the disability insurance company makes a final decision is a real departure from any other civil case and lawsuit and gives a tremendous advantage to disability insurance companies. Simply put, a knowledgeable ERISA attorney will not have the ability to generate and submit evidence if you contact them after obtaining a final decision. Please understand I am not stating you do not have a claim in federal court, you do and we can still obtain disability benefits for you even if we did not represent you during the appeals process, but we prefer to be involved much sooner during the appeal process.
While the legal concepts concerning your disability claim are complex, what you need to do is simple. You should consult with a knowledgeable ERISA disability attorney even while you are still working and contemplating filing a claim, in order to learn your legal rights and what to expect. As stated earlier, at the very latest – contact a knowledgeable ERISA disability attorney ONCE you receive the first denial of your claim.
If your claim has been denied for the first time, you should have 180 days to appeal and this will give us sufficient time to properly develop your case and to submit your appeal. For many years we have had tremendous success at representing clients before disability insurance companies and have a proven system to obtain your benefits. Call us at (800) 588-1710, for a free consultation if your claim has been denied so that we can help you establish a game plan to prove your case so you can get the benefits you have worked for and deserve.
© 2015 Scott E. Davis, Disability Attorney