Clarksburg ERISA Disability Appeals

The Employee Retirement Income Security Act of 1974 (ERISA) governs the appeal of disability claim denials when an employee receives disability coverage as a benefit of employment. Appealing a denial can be complicated because it is important to be mindful of the terms of the disability policy as well as the requirements of the ERISA provisions.

Clarksburg ERISA disability appeals should be handled carefully. Opportunities to present supporting evidence are limited, and failure to submit sufficient evidence or comply with deadlines could jeopardize a claim. For this reason, many employees in Clarksburg work with an experienced ERISA lawyer when challenging a denial of benefits.

Appeals Through the Insurance Company

It may seem doubtful that the insurance company will reverse a decision based on an internal appeal, but it happens quite frequently during ERISA disability appeals. In many cases, appeals are evaluated by a different set of staff members who may apply the standards differently.

Another key reason a claim could receive a favorable outcome after an internal appeal is that the claimant has presented additional proof to support the case. Very often, information submitted with the initial claim is incomplete or inadequate. An experienced disability claims lawyer could assist in obtaining and presenting evidence to document the disability so that the insurer will award benefits.

The ERISA Appeals Process

ERISA requires disability claimants to exhaust all administrative appeals before they may file a claim for benefits in court.

Administrative Appeals

In most cases, an administrative appeal means appealing a denial through the procedures established by the insurance company. Some companies have a process that presents two opportunities to appeal a decision. Others may provide only one chance to appeal, while still others may not even specify how to appeal a denial of benefits.

The administrative appeals often provide the last opportunity to present new documentation demonstrating eligibility, so an experienced legal advocate could help ensure that a claimant procures and presents the best available evidence at the appropriate time. A Clarksburg attorney familiar with ERISA requirements could also keep on top of deadlines and lay the groundwork for an appeal in court.

Federal Lawsuits

ERISA guarantees claimants the right to file a lawsuit in federal court in most cases when an insurer denies a claim on appeal. Clarksburg ERISA disability appeals may be reviewed by a district court judge based entirely on the written record, so it is essential to present the best case in the initial filing. The standard of review can vary according to circumstances.

In some cases, the judge may conduct an independent review based on evidence in the file. In other situations, the judge may only reverse the insurance company’s decision if the evidence indicates the denial was arbitrary and capricious.

More Information About Clarksburg ERISA Disability Appeals

A determination as to whether an employee should receive disability benefits is based both on laws and on the contractual terms in the insurance policy. Each situation is unique, although some factors remain critical in all Clarksburg ERISA disability appeals.

Claimants must demonstrate that they meet the eligibility requirements contained in the disability insurance policy. In many cases, this requires evidence of vocational suitability as well as medical conditions. Those seeking more information about or assistance with ERISA disability appeals are advised to consult an experienced attorney.