When you have a long-term disability benefits plan through your employer, it usually is subject to the terms of the Employee Retirement Income Security Act (ERISA). If you apply for long-term disability benefits from an ERISA-governed plan and your insurer denies you benefits, you must follow the required appeals process before you can challenge the denial in court by filing a lawsuit. If you fail to follow the requirements for appealing, then you risk losing your right to appeal the denial or file a lawsuit regarding the denial in the future.
ERISA requires that you exhaust your administrative remedies before you turn to the federal courts for relief. This means that once you receive a denial of benefits notice from your insurance company, you must follow their internal review or appeals process before you file a lawsuit challenging the denial.
Most ERISA-governed insurance policies required you to first file an informal administrative appeal with the insurer before you consider court action. Under ERISA, the insurance company can require that you go through no more than two levels of administrative appeals before you exhaust your administrative remedies. While requirements for these informal appeals vary from one policy to the next, you must pursue this avenue of relief no later than 180 days after you received an initial denial of your claim for benefits. Otherwise, you will forfeit your right to appeal, which makes it impossible for you to eventually file a lawsuit over the issue.
If you attempt to file a lawsuit prior to exhausting your administrative remedies through the insurance company’s internal review process, the court will dismiss your case. Until you have gone through the informal appeals process with the insurer, no matter how futile it may seem, you cannot file a lawsuit. It can benefit you greatly to get legal advice about all the potential means of building and maintaining the most effective ERISA long-term disability claim possible and guidance as to the pitfalls to avoid. Bonnici Law Group provides skilled, aggressive legal representation on a regular basis for individuals who are seeking long-term disability benefits under insurance policies governed by ERISA. Our priority is to represent your interests and protect your rights to the benefits that you deserve. Call us at 619-259-5199 and schedule an appointment to meet with us about your case today.