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.
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.
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:
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.
Michelle not only won our case for me, but was totally professional, confidence inspiring, and reassuring. I felt I was in really good hands each step of the way. After it was all over and I was receiving disability benefits, my spouse and I looked back in retrospect and felt strongly that we could not have made a better choice in disability attorney for my case. Strongly recommended!
I had this misfortune of being denied long term disability under a ERISA policy through my former employer. I was terrified I was going to end up on the streets disabled with nowhere to go since the condition put me down from work and I lost my employment as a result. I was fortunate enough to have been referred to Michelle Roberts who quickly took my case after a review and I received a very fast response and request from the firm to take over my case. I was relieved as within a matter of just days she was diligently…
I am incredibly grateful for Michelle's expertise, wisdom and innovative approach in helping me navigate a quite challenging, and emotionally charged legal situation. Not only was she on point, intelligent and progressive, she was also compassionate and empathetic to the specific challenges in my case. I truly believe she had my best interest in mind, both immediate and long term, and advised me accordingly. Michelle spent a lot of time understanding the complex issues, researching the latest information and opinions around the matter, and handled the resolution with the utmost confidence and professionalism. I highly, highly recommend her and would…
Michelle is one of the most intelligent, professional to the point person I’ve ever dealt with. She has great listening skills and a gentle way of getting to the root of the issue. As a sales professional for 45 years I could have learned a lot from her.
There’s no question that Michelle is one of the most brilliant lawyers one can have the privilege of working with. She’s a partner and consecutive Super Lawyer, so she’s clearly an amazingly capable attorney. But in my experience, what makes Michelle unique on top of her impressive record is her empathy and passion for helping her clients. Michelle has been there for me in action (not just words) every step of the way and has been an unshakable stand of advocacy for my rights and benefits, independent of whether there was a guaranteed return, which is a rare attribute for…
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