Preparing an ERISA Claim
If your employer’s insurance company denies your claim for disability benefits or other insurance coverage, a federal law called the Employee Retirement Income Security Act (ERISA) enables you to appeal that denial. Your appeal is an important second opportunity to have your claim approved. It is also an important procedural step that preserves your right to eventually file a lawsuit fighting the denial of your benefits.
At the Law Office of Robert F. Keehn, in Los Angeles, we can help you make this appeal. Our firm has a proven record of success in ERISA cases and serves clients throughout California.
Checklist of Questions
Because of our experience in these cases, we are very familiar with the steps that need to be taken for a successful appeal of a disability claim denial or taking your case to a federal judge. When you contact our office, here are some of the things we will need to discuss.
- Which insurance company denied your claim?
- Who is your employer?
- If you are making a disability claim, what is the nature of the disability?
- Was your claim paid for a period of time, or denied at the outset?
- How old are you?
- Have you applied for Social Security?
- What specialist are you seeing?
- What specialists are verifying your disability?
- Does the insurance company claim to be having trouble getting some of the information they say they need to decide your case?
Our firm works with clients with wide-ranging income levels, from yearly earnings in the mid-five figures to six- and seven-figure incomes. Regardless of your income level, we know how important it is for you to get the disability or other benefits that you worked for and deserve.
Tests for ‘Disability’
If your case involves disability benefits, we will need to know whether your employer paid you for a period of time after you suffered the disability. Many people get paid for 24 months before they are cut off.
At the outset of your claim, your entitlement to a disability test usually is based on the job you had at the time you became disabled. But the test for disability often changes after a year or two of disability payments, with the result that it becomes more difficult to continue receiving benefits. This is because there are distinctions in most employer-provided disability plans between being disabled from your own occupation and being disabled from any occupation for which the insurance company decides you are qualified based on your education and occupational experience.
Resolving Cases With ERISA
What we have going for us, as we pursue your appeal, is that ERISA requires the insurance company to disclose all the documents they have relied on in making their decision.
With your authorization, we will get your file from the insurance company and founding attorney Robert F. Keehn will review it thoroughly. We will also insist that any additional documentation needed for a judge to decide your case be included in it.
After the initial claim denial, ERISA cases do not involve much exchange of information between the parties beyond the exchange of file materials prior to and during the administrative appeal. But that exchange can be of crucial importance to your appeal, and to any lawsuit that may become necessary following the appeal. These cases are not decided by a jury, but rather by a federal judge, and the judge usually will decide the case based only on the materials in the file at the time the appeal was denied. Therefore, we’ll make sure your file has the information the judge needs to decide your case fairly.