If your claim for Short Term Disability, Long Term Disability, medical or other benefits have been denied … and the claim is governed by ERISA … you have the right to appeal. You not only have the right, but you are probably required to file an appeal.
When filing an appeal, it is critical to address any issues raised in the initial denial and to provide additional medical information or other evidence to support your claim. In most cases, you have at least 180 days from receipt of a denial notice to file an appeal. The second review of your claim is also generally a 45-day process, with various reasons that the timeline may be extended with notification to you for an additional 45 days (a total of 90 days). However, some employee benefit plans require two levels of review of a denied disability claim. If your appeal is denied after the first review, the plan must allow you a reasonable period of time (but not a full 180 days) to file for the second review.
If your claim is denied again on appeal, the plan or its insurance company must give you a written an explanation, and advise you of your right to go to Court.
The appeal is often one of the most important parts of an ERISA case. It may be helpful to have an experienced ERISA lawyer assist with your appeal, and to help you obtain the benefits you need to support yourself and your family!