Bringing a legal appeal against an insurance company after a disability benefits denial is an uphill battle. The deck is stacked in favor of the insurance industry in many ways. Let’s take a look at those challenges to see what a Texas ERISA lawyer you can do to give you the best possible chance to succeed.
Fighting an ERISA Claim Denial
Finding a Lawyer: It’s important to know that the first step in appealing a long-term disability claim denial is an administrative appeal, not a civil court case. Most lawyers are not familiar with this administrative process. While people often turn to a lawyer who helped them in the past with a divorce or business problem, in a highly specialized area of lawlike disability claim denial, you will want someone with experience handling ERISA claims.
Missing Deadlines: The administrative process is deadline-driven. If you miss any deadlines, you could lose your ability to ever get disability benefits. Your ERISA lawyer will be well aware of all of the deadlines and will keep your case on track.
Airtight Evidence: The next challenge comes with defining the nature and impact of your injuries or illness. As careful as you may be in describing your disability and how it impacts your ability to work, insurance companies find ways to misinterpret and misconstrue this information. Your ERISA lawyer will take great care to ensure the evidence in your case is complete, thorough, accurate, and well-supported by medical evidence.
If your case is appealed to a judge, the judges can only look at the information that is ALREADY in the administrative record– the record that caused your claim to be rejected in the first place. If you worked with a lawyer early in the process, the information you need for an appeal should be available in the administrative record.
Conflicting Medical Opinions: You have a right to work with a doctor who is qualified to provide care and treatment for your specific condition or disability. And yet your insurer may not agree with the opinion of your doctor. Insurance companies can hire their own doctors to give them a second opinion.
In a civil case, a lawyer could question the motives, integrity, and conflicts of interest of a doctor who has repeatedly worked on behalf of a particular insurance company. That does not happen in an ERISA appeal.
In 2003, the U.S. Supreme Court held that long-term disability insurance companies do not have to defer to the opinion of their personal treating physician when evaluating a disability claim. Why don’t they have to listen to the doctor that knows you best? Because when the law was written, it didn’t specifically say that they had to.
This is a significant challenge but experienced ERISA lawyers fight this battle every day and they get results. If you want to fight an insurance claim denial, work with a law firm that has handled many ERISA cases. Call the McKinney or Richardson office of The Fell Law Firm at 972-450-1418, or contact us online to talk with an ERISA attorney with experience.
