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Options when an ERISA appeal is denied

| May 28, 2021 | ERISA

Many people in New Jersey have short- or long-term disability benefits provided as a part of their employee benefits packages. Short- and long-term disability can provide important financial safety nets for workers who suffer illnesses or accidents that leave them facing temporary or permanent disabilities and are unable to work. Since these plans are covered by the Employee Retirement Income Security Act, people must go through the internal claims process of the insurance company and exhaust their remedies with the insurance company before they can file lawsuits.

Appealing within the company

If a disability benefits claim is denied, the employee must file an appeal within the insurance company’s internal appeals process. Many companies have a couple of levels of appeal. People must exhaust their appeals before they can file lawsuits. If you try to file a claim with the court without exhausting your remedies, your claim will be denied. If you exhaust the internal appeals process and are still denied, you can then file a claim against the company in federal court.

When can you file a claim against the company in court?

In most cases, you will need to exhaust the insurance company’s internal process before you can file a claim as previously described. However, if the company’s claims process does not comply with the requirements of the Department of Labor, you could ask the federal court to review your claim before exhausting your remedies. If your plan was not grandfathered in under the Affordable Care Act, you might also have some additional remedies.

The ERISA claims and appeals process can be complicated. If your claim has been denied, getting help from an experienced ERISA lawyer might increase the chances that your appeal will be successful. An attorney may represent you during the internal claims process as well as any claim that might be filed in court against the company to try to recover the benefits to which you might be entitled.