ERISA CLAIMS AND APPEALS
Many employers offer certain benefits to their employees including group disability policies. Although this offer is very attractive to employees, it is often the case that when an employee actually becomes disabled, the insurance company providing the coverage is reluctant to award the benefits which can be extensive. Often times there is a dispute as to whether or not the applicant meets the definition of “disabled.” If this situation arises, the benefit that the employee expected to receive is often denied by the insurance company. In cases involving employment group disability policies, a special law called ERISA applies. In that circumstance, after the denial is made, the applicant usually only has 180 days to put together an appeal packet. That 180 days is extraordinarily crucial in putting together the packet and submitting an appeal. In most cases, it is advisable to seek legal assistance in preparing the appeal as certain materials must be submitted that would allow the insurance carrier to reach a determination that the claim is covered where the claim is otherwise disputed. Persons experiencing a denial and attempting to deal with the denial themselves without the assistance of a lawyer often fail to submit materials that are crucial for later determination. If the matter is filed in Federal Court, typically you do not get an additional opportunity to submit new materials, or materials that otherwise may serve as a basis to change the outcome of the matter.
Our firm routinely does ERISA type claims and is skilled in preparing appeal packets. Further, if an insurance company continues to deny the claim, our firm also has extensive experience litigating the matter in Federal Court. The attorney at our firm specializing in this area of law is Attorney David D. Dauland he would be happy to assist you in your case.