Long-term Disability, Denied or Terminated Claims
APPEALS AND DEADLINES
If you are denied LTD benefits, or if they are terminated, it is imperative that you address the decision immediately in order to protect your rights.
Normally, LTD benefit plans give you the right to appeal a denial or termination of your benefits. The “appeal” actually is an internal review by the LTD insurance company or other plan administrator. There are very specific deadlines which must be followed exactly. IF YOU MISS AN APPEAL DEADLINE YOUR CLAIM FOR LTD BENEFITS COULD BE LOST FOREVER.
CAN’T I JUST SUE THE INSURANCE COMPANY?
Most appeals are mandatory. In other words, IF YOU FAIL TO APPEAL WITHIN THE TIME PERIOD ALLOWED, NORMALLY YOU CANNOT GO TO COURT AFTER AND ASK THE COURT TO REVERSE THE DENIAL OR TERMINATION OF YOUR BENEFITS. LTD plans may require either one or two of these internal appeals to the insurance company or other plan administrator. Again, each plan is different, it is therefore important to contact BEEDEM LAW at 800.300.9772 as soon as your LTD benefits are denied or terminated.
HOW LONG DO I HAVE TO APPEAL?
Under ERISA, normally you have 180 DAYS after you receive the letter or notice informing you that your LTD benefits have been denied or terminated in which to make your first appeal. If a second level of appeal is available, you need to find out what the time limit is under your LTD plan and treat it very seriously. If a second level of appeal is available, it is usually mandatory.
As stated earlier, EACH PLAN IS DIFFERENT. Some appeals periods can be as short as 60 DAYS. It is very important to check the exact provisions and time limitations of your LTD plan.
HOW DO I PREPARE FOR AN APPEAL?
This is arguably the most important part of the process. IT IS EXTREMELY IMPORTANT TO COLLECT ANY AND ALL MEDICAL RECORDS, DOCTORS’ REPORTS, VOCATIONAL REPORTS AND PHYSICAL AND MENTAL EVALUATIONS THAT YOU EVERY WANT TO BE CONSIDERED AND SUBMIT THOSE WITH YOUR APPEAL.
Normally, you will not have an opportunity to submit additional documents or other evidence in support of your claim after the appeal process is complete (in other words, after the LTD insurance company or other plan administrator has finished its internal appeal process). Obtaining and submitting all evidence with your appeal is especially important if you ever want to go to Court and ask the Court to reverse the denial or termination of your benefits. In most cases, a Court will not look at or consider any documents or other evidence that was not submitted to the insurance company or other plan administrator during the internal appeal process.
WHEN SHOULD I HIRE A LAWYER?
Probably the most important time to have a lawyer represent you is IMMEDIATELY after your LTD benefits have been denied or terminated.
CLAIM FILE DOCUMENTS. You have the right under ERISA to request copies, without charge, of nearly all documents in your LTD claim file, as well as video surveillance tapes. In other words, you have the right to see nearly all of the information the LTD insurance company or plan administrator has considered in deciding whether to grant or continue your LTD benefits. Your attorney is in the best position to make that request for claim file documents and then review those materials for purposes of making a legal claim, either by an internal appeal process or by brining a lawsuit in Federal Court. USUALLY THIS IS THE FIRST THING BEEDEM LAW WILL DO. The documents should be sent within two to four weeks of being requested.
BEEDEM LAW will review the letter notifying you of denial or termination of your LTD benefits. We will also review the LTD plan summary.
At BEEDEM LAW, we will use our professional training and experience to determine what records, reports or other evidence should be obtained for your appeal. It is important that BEEDEM LAW has as much time as possible before your appeal is due to be able to collect evidence supporting your claim. Obtaining records and reports and in some cases having you evaluated by a vocation expert may take several months, so every day is important!
HOW DOES BEEDEM LAW GET PAID?
BEEDEM LAW handles claims for LTD benefits on a percentage contingency basis. A contingent fee means that we do not receive any fee if no benefits are obtained through our efforts. Our fees are explained in detail in a retainer agreement which is signed when BEEDEM LAW agrees to handle your claim.
BEEDEM LAW also does not charge for initial conversations or to request and review your entire file from the insurance company, which you are entitled to receive without charge under ERISA, to determine if we can help you. If we determined that we cannot handle your claim on a contingent fee basis, you owe us nothing.
Please call 800.300.9772 without charge or obligation to discuss your LTD benefits claim.
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