What is an ERISA Disability Appeal?

Brandon Osterbind of Osterbind Law gives a definition of an ERISA appeal. An ERISA appeal is the process of trying to change your insurance company’s mind about your long-term disability claim after they have denied it. You must gather all of the evidence that supports your claim, fill out all necessary paperwork, get doctors to vouch for your claim, etc. If you don’t have the right information, you’ll simply be denied again. If you cannot get the insurance company to change their decision about your claim, you can take them to court and let the judge decide whether or not you qualify for long-term disability based on the evidence and information that you’ve provided.

Why is an ERISA disability appeal so challenging?


Why is it so hard to put together an ERISA appeal? Because there’s so much paperwork involved. An ERISA appeal requires information such as medical reports, vocational reports, educational records and reports, testimonies and questionnaires from medical experts and more. The necessary paperwork can add up to hundreds of pages of detailed, expert information. Also, this information will need to be gathered and organized in such a way as to be accurate, complete, logical and persuasive. Many people in need of disability find it difficult to do this because of the time, energy and mental or physical toll it takes to put this appeal together. Many who are disabled simply don’t have the ability or the time to do so. Also, there are time limits and deadlines for this appeals process, and if you don’t get the necessary information collected and turned in on time, you could lose the ability to appeal your disability case forever. 

Why should I hire an attorney for my ERISA disability appeal?


Why hire an attorney to help with your disability claim appeal process? Because if you’ve been denied disability by your insurance company, it means that they have likely already consulted with attorneys and medical experts who are on their side about your claim. They will have obtained professional opinions on your information and disability claim that invalidate it and provide a basis for the denial. The point of the ERISA appeal is to level the playing field and get expert opinions on your side in order to change the insurance company’s mind about your disability claim. This is where hiring an attorney comes into play. Your attorney will look at your claim and all the information and reports that you’ve gathered to determine what information you have—and more importantly, what information you don’t have and need to obtain in order to have a successful appeal. If you submit the appeal and are denied a second time, you may have no choice but to take your claim to a federal district court judge. If you do that, you’ll need to be sure that your claim is rock solid and accurate so that the judge will decide that the insurance company has abused its discretion in denying your claim. Osterbind Law can help you with your case, whatever the circumstances of your disability or wrongful injury may be.

What does an ERISA disability appeal look like?


The ERISA appeal process begins with the attorney sending a letter to your insurance company requesting all of the information about the disability claim and their reasons for denying it. The attorney will then analyze the information in order to attempt to disprove or challenge the information on which the insurance company was relying. The information they could have been using may have been inaccurate or incomplete. From there, you and the attorney must produce the correct evidence and information to substantiate your claim to disability. All of the information you gather must be put into a legal document called an appeal letter that explains to the insurance company why you should be approved for disability insurance. You have 180 days after your denial to complete this process. Once the insurance company has the information, they have 45-90 days to reach a decision. If they deny the claim again, you can either take the appeal to the court and present the case to a judge, who will have the authority to say whether or not the insurance company has abused their discretion. However, depending on your insurance company’s policies, you can also try once more to convince the insurance company of the validity of your claim. This entire process is complicated and can take a total of 2-3 years. Osterbind Law of Central Virginia can help you as you go through this appeals process.



How will I pay for an ERISA disability attorney?

What does payment look like when hiring a disability attorney? Many people can’t afford an attorney when they’ve become disabled, so the attorney will charge a contingency fee. This type of fee means that the attorney will only get paid for their services if they win the disability case. They assume a great deal of risk in the case, and will not be paid if they lose the disability appeal to the insurance company. However, if the appeal is won, the fee can be up to ⅓ of the total earnings. Attorney fees and costs are different, however. The Virginia Bar requires that your attorney bills you for the costs that they spent on the case, such as obtaining medical records, filing fees with the court, and sitting down with your doctors. These costs can be easily recovered if the case is won, but even if it isn’t, you’ll still be billed for those costs. Osterbind Law of Central Virginia can help with your disability claims and appeals.

Why do insurers deny long term disability claims?

Why would an insurance company deny a long-term disability claim? There are several reasons. The most common reason is that not all of the information required to determine eligibility for disability was provided to the insurance company. Because of that, the insurance company is able to say that the claim cannot be substantiated and has been denied due to the lack of information. Another reason is that the information you provide to the insurance company isn’t specific enough and doesn’t go into enough detail about your injuries, symptoms, and reasons for not being able to work. The insurance company may also have studied the information provided and picked phrases out of context that suggests that you’re not disabled and that your claim is invalid. The rest of the information, such as medical notes from doctors, may detail your symptoms, but if the insurance company can find something small that indicates that you aren’t disabled, they can use that against you. The best way to convince the insurance company to approve your claim is to provide a high quantity of specific and accurate information so that they will not be able to deny your claim.

How many times can you appeal a disability denial?

There is usually one appeal opportunity after your insurance company denies your disability claim. This appeal is a short period of time (usually about 180 days) in which you have the opportunity to submit more information to substantiate your claim. If your appeal is denied again after this, there may be a mandatory or voluntary secondary appeal opportunity, depending on what is in your insurance contract. Do what you can to solve the matter with your insurance company, because after a final denial letter, your only other option is to take the case to the federal district court and maybe even beyond, and let a federal judge decide if you meet the terms of disability as listed out in your insurance contract. But your best chance for a successful appeal is at the insurance company level. Osterbind Law can help you with your disability appeal process.

What should I bring with me to my first meeting with an ERISA disability lawyer?

To prepare for an attorney consultation about disability denial, you need to collect and bring along some key pieces of information. Make sure you bring the letter from the insurance company about why you were denied, your disability application, policy information from your insurance company and any other medical information you have about the disability. The attorney will look at all of this information and find out what parts were important to the insurance company in denying your claim, and from there, your attorney can decide if they think you will win or lose this claim. If you don’t bring the right information to your consultation, your attorney will not be able to help you properly and won’t be able to tell if you have a case. Osterbind Law of Central Virginia specializes in wrongful hurt and death cases and much more, and can help you in your disability appeal process.