Under ERISA, more than two-thirds of disability claims are denied, according to government statistics. The Employee Retirement Income Security Act (ERISA) requires plan administrators to give a “full and fair review” before denying a claim. It can be an exhausting and confusing process for people who may already be feeling overwhelmed or vulnerable.
A Full and Fair ERISA Review
Under ERISA, claims begin with the plan managers. Most benefit plans will have some kind of an internal appeal process by which claim denials are reviewed, administratively. As a general rule, the claimant must exhaust that internal review process before he can file a lawsuit.
While a benefit claim is working its way through that internal system, though, the insurance company or plan manager may well be building what the law calls an “administrative record.” It can include any medical records, reports, vocational reports or bills submitted by the claimant, as well as any claim-related correspondence. It may also include any internal reports of the plan’s own reviewing physicians or vocational “experts.” The law says that managers don’t have to disclose these internal records to someone making a claim. Frequently, plan administrators and insurers build their own private administrative record; the people fighting for their rights don’t find out about those records until they’ve had to hire a lawyer and go to court.
For a free legal consultation with a paperwork lawyer serving McKinney, call (972) 535-6377
Creating the ERISA Administrative Record
Getting the administrative record right can be essential to a successful case. Courts usually restrict their review to the administrative record. Judges often defer to plan administrators so it can be enormously helpful to put together an administrative record that supports your disability claims. How can you do this?
- Don’t assume you have enough evidence if your employer says you’re unable to work. The insurance company will make this decision based on the legal definition of disability under your plan or policy.
- Don’t rely solely on your human resources department; consult an attorney. While well-intentioned, your HR department is likely not qualified to interpret insurance policies.
- Don’t rely solely on the forms the insurance company gives you. Your doctor can and should provide additional, more detailed documentation.
- Do not participate in activities that your doctor warns you not to do.
- Do not rely on the insurance company’s lawyers to file your disability claim. They do not work for you and are ethically obligated to do what is best for the insurance company, not for you.
- Work with an attorney experienced in ERISA claims. ERISA legislation is complicated and expansive. You need to get your claim right the first time.
- Lawyers that do not regularly handle ERISA claims can do more harm than good. Don’t let inexperience jeopardize your claim!
McKinney Paperwork Lawyer Near Me (972) 535-6377
Contact an Experienced ERISA Attorney
The ERISA disability application, review, and appeals process can be exhausting and confusing for people who may already be feeling overwhelmed or vulnerable. The ERISA lawyers at Underwood Law Office have decades of experience helping people through the ERISA maze. If you or a loved one needs help, we’re ready to go the distance with you: Contact us for a free consultation today. The phone number for our McKinney, Texas ERISA lawyer is (972) 535-6377.
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