Top Chicago ERISA Attorneys Will Guide Your Appeal, From Start to Finish

When an individual receives a denial of a valid insurance claim, they often have the right to file a legal claim against their insurer to obtain the proper benefits under their coverage plan. If your insurance plan is an employer-provided plan regulated under the Employee Retirement Income Security Act (ERISA), however, there are highly specific and strict procedures for appealing a claim denial. Because the appeals process can be complex and confusing to many people, it is always advisable to consult with an experienced ERISA litigation attorney for assistance throughout the appeals process.

With an ERISA appeal, you cannot simply go marching into court. Instead, you must first appeal internally in accordance with your policy rules. Most ERISA group long term disability policies allow for two or three appeals on the internal administrative level. ERISA sets a short deadline for appeal at 180 days after after being notified of the denial. This is a short deadline because it can take time and effort to build a strong case for why the denial should be overturned. Because of this strict 180-day deadline, it is critical to contact a qualified ERISA lawyer as soon as you learn that your claim was denied.

During this period, an attorney may do some or all of the following:

  • Gather medical records and organize them in an accessible manner;
  • Arrange for an additional medical evaluation or a functional capacity evaluation (FCE) to obtain additional evidence of your disability;
  • Obtain the analysis and opinion of a vocational expert regarding your job limitations based on your medical condition, training, experience, and educational background; and
  • Seek any other evidence that may be helpful to prove your disability claim.

It is imperative to submit the strongest case possible on your internal administrative appeal, as this is also the file a court will review if a subsequent legal claim is necessary.

If you are unsuccessful in your internal appeals, you can file an appeal with the district courts in Illinois. ERISA sets out no specific time limit (called the statute of limitations) in which to do so, therefore, courts often use the statute of limitations for contracts in Illinois (ten years) or use a reasonable limitations set out in your particular insurance policy. If the appeal is properly filed, the court will review the administrative appeals file and determine whether the decision was justified.

Call For A Free Consultation With A Chicago ERISA Attorney

Appealing an ERISA denial can be complicated and can have many requirements that are different from other types of insurance appeals. An insurance attorney may not understand the unique legal issues that may arise in this type of appeal or may not be aware of important deadlines, so it is critical to consult specifically with an ERISA litigation lawyer who thoroughly understands ERISA and the appeals process under this law. Roberts Bartolic LLP is committed to assisting individuals in Chicago with this specific type of ERISA case and, therefore, has the knowledge and skill needed to successfully handle ERISA appeals. Please call today at 312-635-1600 to discuss your situation today.