My long-term disability claim was denied. Can I sue?

If you submit a long-term disability claim and receive a rejection letter, don’t fret. An initial denial is not the final word. Under disability plans governed by the Employee Retirement Income Security Act (ERISA), there are avenues for having your claim reconsidered.

Step one, however, is not to file a lawsuit. First, you have to follow the plan’s procedures.

Start with an internal administrative appeal

Under ERISA, a long-term disability plan has to offer a way for claimants to appeal a decision, as well as provide an explanation for that process. After an initial rejection, the next step is almost always an internal administrative appeal, which has to be filed fairly quickly after receiving a denial.

With this administrative appeal, you’re asking the insurance company to reconsider their determination. You’re not simply repeating the previous step, however. You are generally able to provide new evidence to support your claim and help your case. Including information that directly addresses the insurance company’s reason for denying your claim can be crucial.

Only once you’ve exhausted this internal appeals process can you consider taking the matter to court.

Filing a lawsuit

If an insurance company denies your long-term disability claim appeal, you can consider filing a lawsuit in federal court. A judge will review your case and determine whether your claim was wrongly rejected.

There is a small catch. At this stage, you generally won’t be able to include any new evidence. The judge will only review the information you offered as part of the initial claim and during the internal administrative appeal.

Because of this, it’s vital to consider the help of an attorney as soon as possible after your initial denial letter. By utilizing the services of Alan C. Olson and Associates before filing an internal administrative appeal, you can help make sure your long-term disability claim is ready to stand up to scrutiny not just immediately, but into the future as well.


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