Wrongfully Denied ERISA Disability Benefits? Take These 5 Steps

Receiving a denial of disability benefits under an Employee Retirement Income Security Act (ERISA) covered plan can be a perplexing and stressful experience. It’s crucial to understand that a denial is not the end of the road. There are steps you can take to contest the decision, potentially overturning the denial and securing the benefits you rightfully deserve.

Monahan Tucker Law focuses its practice on guiding individuals through the complex process of appealing a denied disability insurance claim. We are passionate about helping claimants ensure they are well-equipped to challenge the denial effectively. Here are five steps to take if your claim for long-term disability (LTD) benefits was recently denied.

1. Requesting the Administrative Record

The first step in contesting a denial is to request a copy of the administrative record for your claim. This record is pivotal as it contains every piece of information the insurance company considered when making their decision. When a claim is denied under an ERISA-regulated plan, the insurer is required to provide a copy of the administrative record within 30 days of receiving your request.

By obtaining and reviewing the administrative record, you can gain clear insights into the basis of the denial. This will also allow you to identify any potential errors or inconsistencies within the insurer’s evaluation process. Understanding the insurer’s reasoning is fundamental to building a strong appeal.

2. Reviewing Plan Documents for Coverage

It’s imperative to review all relevant plan documents. Ideally, this should be done before filing your claim, but it can also be helpful after receiving a denial. These documents outline your entitlements and the criteria for coverage. Familiarizing yourself with these details ensures that you meet the plan’s requirements for coverage. Additionally, this step can help uncover any discrepancies or issues that may have contributed to the denial of your claim.

3. Understanding the Denial Letter

The denial letter serves as a critical piece of communication from the insurer. It details the specific reasons for the denial of your claim. A thorough review of this letter is necessary to address the insurer’s concerns directly. This review is foundational to preparing for an appeal or litigation, as it helps pinpoint the areas that need to be challenged or clarified.

4. Supplying Evidence to Challenge the Denial

After understanding the rationale behind the denial, the next step is to gather and provide evidence that challenges the insurer’s decision. This may involve procuring additional medical records, expert opinions, or vocational evidence that supports your claim. The goal is to demonstrate conclusively why the denial was inappropriate and to validate your entitlement to the claimed benefits. Compiling a robust body of evidence is crucial in strengthening your position.

5. Contact a Knowledgeable Disability Claims Attorney

Securing the services of an experienced disability insurance attorney may significantly enhance your chances of overturning a denial. An attorney who understands the complexities of disability claims under ERISA-covered plans can provide invaluable assistance throughout the appeals process, ensuring that all procedural requirements are met and that your appeal is filed within the strict deadlines imposed by ERISA regulations.

Working with a disability insurance attorney can also help relieve the burden on claimants by managing the complex and often frustrating process of appealing a denial or pursuing litigation. Their representation can provide claimants with valuable peace of mind during a challenging time.

How Monahan Tucker Law Can Assist

Monahan Tucker Law possesses deep experience in both ERISA and non-ERISA litigation. Our team is adept at navigating the complexities of disability insurance claims, providing comprehensive legal guidance and representation. We are committed to advocating on behalf of individuals who have been unjustly denied disability benefits. With Monahan Tucker Law, you gain a partner equipped to challenge denials effectively, aiming to secure the benefits you are entitled to.

If you or a loved one are dealing with a denied claim for disability benefits, please don’t hesitate to reach out and learn how we can assist you. Monahan Tucker Law is here to provide the support and advocacy needed to pursue a favorable outcome.