Yes. While you can submit your own ERISA disability appeal, doing so is risky. This is because the strength of a lawsuit depends on the quality of the appeal. Because ERISA cases at litigation are treated as a review of the administrative record (i.e., evidence submitted during the appeals process), a poorly prepared appellate record can severely hurt your case. Except in very limited circumstances, new evidence cannot be submitted after an appeal. So appealing is your one chance to ensure a strong case, particularly if filing a lawsuit becomes necessary to get your benefits.
Sadly, we may need to decline a case if we do not have the opportunity to develop the record on appeal. This is because the administrative record must contain evidence strong enough to overcome the deference a federal judge likely applied toward the insurance company’s decision. When you hire our highly experienced disability lawyers, you can be assured everything possible was done to prevail in every appeal because these efforts establish the likelihood of success at litigation.
The ERISA disability appeals process can feel discouraging and overwhelming, but you should not give up on the disability benefits you deserve. This is exactly what the insurance company hopes you will do. Call us for support and know you are not alone in this process.
Also, if your claim is governed by ERISA, you are generally required to exhaust the appeals process before bringing a lawsuit. This means, if you do not appeal, you could lose the ability to pursue your benefits. And, your ERISA disability appeal matters! Unlike other areas of the law, ERISA largely limits the evidence you are allowed to present in court to the evidence you present in support of your appeal. Therefore, the appeals process is an extremely important part of your disability case. Even if you are unsure as to whether you want to file a lawsuit, you should still participate in appealing, or forever lose your right to seek benefits later.
This is a key reason ERISA is rotten, because it requires you to appeal to the very entity that denied you in the first place. Even the strongest appeals are sometimes denied, because you are dealing with an insurance company that often has a financial conflict of interest to act against your best interests. This conflict exists when the insurance company is both paying your claim and making determinations about benefits. When this conflict exists, insurance companies will deny even valid claims, in the hopes that claimants will get discouraged and abandon the process, thereby saving them money.
You generally do not have the right to a jury trial if you have to file a lawsuit. And, any lawsuit you bring is generally limited to the record you developed on appeal.
- This discretion means that a federal judge reviewing your claim will use an “abuse of discretion” standard of review, giving deference to the insurance company’s decision and only overturning it if unreasonable. The analysis is complex, and having a skilled attorney is important to ensuring you get the most favorable standard of review possible.
- Reasonableness is an easy standard for the insurance company to meet. Even if the insurance company’s denial is based on nothing more than a doctor conducting a paper review of your claim, in certain circumstances, that can be enough to defeat your claim. In ERISA, a federal judge does not have to defer to your treating providers’ opinions—they do not even need to necessarily agree with the insurance company.
Rather than a jury of your peers reviewing the insurance company’s conduct, you only get a federal judge to review and make a decision, and their decision will be based solely on the evidence provided on appeal. You cannot submit new evidence to the judge, and you will not be able to testify about your medical conditions or any harm caused to you.
Due to the importance the appeals process is to a potential lawsuit, always consult with a disability attorney before submitting ERISA disability appeals and before filing claims to avoid any pitfalls. You are entitled to representation and we can help you like we have so many others. We routinely go up against insurance companies and know what it takes to get your benefits. With so much at stake to protect your livelihood, don’t go at it alone.
For more information check the U.S. Department of Labor website.