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Long Term Disability

ERISA Long Term Disability Appeal Attorneys in San Francisco

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 the expertise in understanding 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, our focus is on representing individuals with denied benefit claims under the Employee Retirement Income Security Act (ERISA). Because we focus 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.

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 put together a comprehensive and thorough appeal letter. Due to COVID and changes in the regulations, you may be entitled to more than 180 days to appeal. Contact us to find out.

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 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.

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We know how to get your insurance claim paid. Call today at:
(510) 230-2090

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