Bridgeport ERISA Disability Appeals

Once you’ve filed your ERISA long-term disability benefits claim, you wait for the insurance company to approve it hopefully. Often, however, applicants receive a notification of denial.

A denial can be frustrating because you must understand the claims’ perceived deficiencies and respond promptly. The insurance company’s justification could be confusing rather than provide a meaningful explanation for the denial.

A Bridgeport ERISA disability appeals attorney could help you get your claim back on track. Attorneys familiar with the nuances of ERISA law could advise you on how to strategically resubmit for success so that you can receive the benefits you need.

The ERISA Disability Claim Process

Before filing a claim, a claimant needs to gain an understanding of the policy terms, coverage, limitations, exclusions, and deadlines. Next, a claimant must gather the proper medical certification. This documentation should show the claimant meets the definition of disabled as stated in the ERISA policy. Claimants should also select an appropriate last day of work while considering their abilities and medical treatment schedule.

In addition, claimants must submit a claim form and certain financial information, such as their salary earnings. All the above information should be accurate and complete to the best of a claimant’s abilities.

Claim Denial

Even when employees try their best to follow the rules and submit successful disability claims, denials are common. In an ERISA disability appeal, it is essential for Bridgeport workers to review the contents of the denial notification as these provide instructions for how to correct the mistakes in the initial claim.

Under ERISA law, insurers must explain why they denied a claim. If it was in part or whole due to medical opinion disagreement, the insurer must state why their physician’s opinion differed from that of the claimant’s doctor.

The notification must also include the precise plan provisions or rules on which it based the denial. The claimant is entitled to reasonable access to copies of the application, review, and decision documents.

Finally, the notice should outline the process for appealing the decision. The timeframe to appeal is especially important.

Appealing an ERISA Disability Benefits Claim Denial

One or two appeals are common steps part of the administrative process that an ERISA disability claimant must undergo before pursuing a lawsuit. If filing a lawsuit becomes necessary, the only material the court considers is that which the insurance company was able to view. Therefore, it is crucial to create a thorough administrative record from the outset and in the appeals process.

To successfully amend a defective claim, a Bridgeport applicant may follow this process when submitting their ERISA disability benefits appeal:

  • Submit a written request for a copy of the claim file from the insurance company
  • Refer to the definition of “disabled” within the policy to understand what a claimant must demonstrate
  • Ensure all pertinent medical records are present, including physician notes, surgical and radiological reports, emergency room records, and photographs
  • Obtain more information from medical practitioners if the denial cites a lack of adequate documentation of mental or physical limitations
  • If necessary, consult a new doctor for a second opinion on the claimant’s medical condition
  • Collect third-party statements detailing personal observations of employee’s limitations from family and close friends

A Bridgeport ERISA Disability Appeals Attorney Could Help

Wading through insurance policies and medical documentation while racing the clock could be stressful. If you applied for and were denied long-term disability insurance benefits, you should not be discouraged.

If the process seems overwhelming, consider consulting a Bridgeport ERISA disability appeals lawyer. Experienced legal counsel could review your claim submission and assist you in building a solid appeal. Reach out to an attorney to get started today.