When you receive a benefit denial letter, you must exhaust your administrative remedies before you are able to file a lawsuit in federal district court. Exhausting your administrative remedies means you must request a review of that denial to the plan administrator or insurance company to convince them to pay your benefits. An effective appeal is more than just writing a letter and stating your disagreement with the claim denial. Components of a successful appeal are multifaceted, and over the years, we have gained a keen understanding of what evidence the insurance company needs to approve a claim. We work with you to gather and submit the relevant information in a timely and effective manner. We have a high success rate of getting insurance companies to overturn their claim denials.

At Roberts Disability Law, P.C., we are dedicated to representing individuals with denied benefit claims under the Employee Retirement Income Security Act (ERISA). Because we concentrate on this area of the law, we understand fully how to gather and develop the pertinent evidence and build your best case. We allow you to focus on your health while we focus on demonstrating the true extent of your disability, so you get the income you need to move forward.

Who We Represent in Long Term Disability Appeals

Our clients come to us for assistance when an insurer has either denied or obstructed their benefits. We work with:

• Professionals With Chronic or Hard-to-Measure Conditions. The insurer denied the claim by saying there was “not enough objective evidence,” even though conditions like fibromyalgia, lupus, or migraines rarely show up neatly on lab tests or imaging. 
• Claimants With Complex Medical Histories. We assist clients whose claims were denied because the insurer labeled the disabling condition as “pre-existing,” citing earlier treatment or overlapping diagnoses. 
• Policyholders Facing Unfair Claim Handling: When an insurer ignores your evidence, drags out the process, misstates your coverage, or acts improperly, we step in to hold them accountable and pursue the remedies available to you.

No matter the exact circumstances surrounding the claim’s denial, we are prepared to evaluate your case and help you file an appeal.

How Much Time Do I Have to Appeal a Denial of Benefits?

The letter you receive from the insurance company explaining the decision to deny your claim should also state the time frame you have to send in an appeal. For disability benefit claims, you have only 180 days after receiving your denial letter to send in a written request for review of the claim denial. It is important that you contact us when you receive the claim denial letter since we need as much time as possible to prepare a comprehensive and thorough appeal letter.

Why Is the Appeal So Important?

One of the lesser-known nuances of an ERISA benefits claim is that the information submitted or generated before the end of the appeals process is often the only evidence a reviewing court will consider when determining whether you are entitled to benefits. The term “Administrative Record” describes all the information that the insurance company receives or generates before it issues a final decision letter on your claim. If the insurance company or plan administrator denies your request for review (also referred to as your appeal), the court will review the Administrative Record and decide whether the insurance company made the correct decision. As such, your appeal is arguably the most important aspect of your benefit claim.  Putting together a strong appeal includes components such as:

• Analyzing the reasons for the denial as explained in your denial letter;
• Requesting your claim file from the claims administrator to assess the complete basis for the claim denial;
• Obtaining, analyzing, and summarizing medical records;
• Obtaining medical assessments;
• Addressing any surreptitious surveillance evidence;
• Obtaining independent medical and/or vocational evaluations;
• Gathering third-party statements supporting your disability claim;
• Preparing a thorough appeal letter that effectively weaves together all the evidence supporting disability.

The team at Roberts Disability Law, P.C. works determinedly to put together a strong appeal for you. Our goal is to get your claim paid before filing a lawsuit.  However, if a lawsuit is necessary, we know how to best resolve or win your claim in federal district court.

Why Choose Roberts Disability Law, P.C.?

We do not practice across every area of law and pick up disability cases when they come in. This is our priority. ERISA disability claims require a specific kind of knowledge, and that skill is exactly what we offer. Attorney Michelle Roberts is recognized by peers and former clients as a trusted attorney in ERISA long term disability matters. That reputation was earned through years of deliberate, dedicated advocacy.

Here is what sets our firm apart:

• Dedicated practice: We concentrate on ERISA and disability benefit claims, which means we understand the nuances, procedural requirements, and case law that generalist firms may miss.
• Proven results: We have helped clients recover benefits from the country’s largest insurers, including in cases that were initially considered difficult.
• Personalized attention: Every case receives careful, individualized analysis, regardless of the dollar amount at stake.

Your Next Step Starts Here

A denial letter from your insurer is not the final word. With the right legal support and a well-constructed appeal, many claimants successfully recover the benefits they are owed.

Roberts Disability Law, P.C. is ready to review your case. Contact us to request your initial consultation. The sooner you act, the more time we have to build the strongest possible case for you.

Frequently Asked Questions About Long Term Disability