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Common questions about ERISA appeals

On Behalf of | Feb 25, 2022 | ERISA

The ERISA system can be very confusing, especially when it comes to disability claims. You know that cannot work and that you need the financial benefits to compensate for your inability to earn. But it’s difficult to know where to start, and more than a little intimidating.

This is understandable, and you’re certainly not alone. To help you start considering all the steps you need to take, here are three common questions that people ask.

If your claim gets denied, can you appeal it?

First and foremost, yes, you do have a right to an appeal. You do not simply have to accept the denial. This does not mean that all appeals are then accepted, of course, but you do have a right to take that step if it seems necessary.The reality is that you not only have a right to appeal, you have an obligation to appeal, at least internally. This is a known as “exhausting administrative appeals” and if you do not do this first, you will not have a right to file suit later on if you need to.

Is there a deadline for this appeal?

Yes. Federal regulations require that you file an administrative appeal with the insurance company no later than 180 days from the date you receive a written denial of your claim. This should be explained and set forth in the paperwork that you get from your insurance company when they make the decision. It will inform you not only of that decision but of your right to an appeal and the timeframe in which you have to do that.

How will you get this decision?

Generally speaking, you’re going to get this decision and all the other information from the company in a written document. If you are being denied, you’re going to get it in writing. If you have been approved, you will often get it in writing, but there are cases in which this is not a requirement.

What options do you have?

If you already have been denied and you believe that it’s time to file that appeal, it’s crucial to know exactly what steps you will need to take and when you need to take them. . This process can be complicated, so it may help to have an experienced team on your side.