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ERISA CASES: ADMINISTRATIVE APPEALS

Phillip A. Tatlow
Phil, Phillip, Phillip A. Tatlow, ERISA, Long-term disability, disability, wrongful death, Union attorney


Erisa cases involving life, accidential death and disability policies are often provided to employees through a group insurance plan for as part of an employment benefit. When these policies are properly written they are controlled by Federal Law entitled ERISA. If you have a claim for benefits, it is important to follow all guidelines in the plan on submission of evidence of the claim, including proof of the disability or cause of death while the administrative appeal is pending. If you do not do so and the claim is denied and there are no more administrative appeals available, your only remedy available is to sue the company in Federal Court. Once a lawsuit has to be filed, the lawsuit is almost always based upon the administrative record that was before the insurance company or claims' administrator that decided the claim. If you failed to introduce important evidence that supports your claim, you can not do so after the claim has been denied. That is why it is extremely important to consult with a qualified ERISA attorney before your final appeal is exhausted. If you do not do so, you may not find an attorney to take your case, or if he/she does, the case may be lost due to failing to introduce some important medical records of your condition or of the cause of death while the administrative appeal was pending. Insurance companies may tell you that you do not need an attorney and that they will obtain all of the necessary medical records. However, it is your burden to submit the evidence to the company on your claim. If you do not do so and it is denied, you can not blame the company for their failure to obtain your records. The court rarely admits further evidence into the record, even if you think it is relevant and should have been used to decide your case.  Therefore, make sure to submit all evidence of your medical problems, or of the cause of death or disablity that the insuance company or claims' administrator needs to decide the claim.

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