Many employees make available to their workers, employer sponsored long term disability plans. These are plans that pay the worker a certain amount of monthly income during periods of disability. These disability plans have complicated rules that can be hard to understand and difficult to follow. It is important to know that if you do not follow the plan's administrative rules that are listed in the "plan documents," the insurance company and employer can deny your claim. If your claim has been denied but you still have a right to appeal the denial of the claim, there are several steps to follow to protect your rights and to make it more likely that you will win your case.
It is difficult to know what to do to protect your rights. The insurance company or plan sponsor may say that you don't need an attorney and that you can appeal the denial yourself. Understand that you can do this, but if you do so, an attorney can not get in new evidence once an appeal is denied. The following is a list of items to help you start the process on the appeal of the denial of the claim.
1) Ask the plan administrator and the claim's administrator (Often an insurance company or an employer/plan sponsor) for all important documents that were used to decide your claim. This should include a request for the claim's file, the plan documents, the summary plan description, all medical records and reports in the case and any vocational evidence used by the company in deciding the claim. Send this request to the plan sponsor and the claims' administrator, in a certified letter from the post office (See our blog on Obtaining Penalties in ERISA cases).
2) Ask your employer for a job description of your most recent job and ask for a list of the essential duties of your job.
3) Make a list of your past employment history, including all jobs and job experience, education and training that you have. Obtain your earnings history (payroll records or copies of checks for at least one (1) year and preferably for the past five (5) years. Include gross income, as well as bonuses and overtime wages.
4) Gather all of the medical records of your conditions that you claim have caused you to be disabled. It is important to obtain all MRI reports, X-ray reports and diagnostic tests that were ordered by your physicians in order to prove the severity of your conditions.
5) Obtain a DVD or disc of your Social Security records and any favorable award letter if you have applied for Social Security. The Social Security office generally has a copy of your file and it can be transferred to a DVD for a small charge.
6) Obtain copies of any worker's compensation claims that you have filed or reports of recent injuries or disabling conditions.
7) Make sure and do not fail to appeal the denial of the claim within the amount of time allowed in the denial letter and the plan documents. If you do not know the time to appeal, consult your plan document, the denial letter or contact the plan administrator to ask the time that you have to appeal the denial of your claim. You may wish to consult with an ERISA attorney before the final denial of your claim or no further evidence will be admissible to win your case. If you exhaust all of your appeals, many attorneys will not take the case because they can not introduce new evidence to help prove that you are disabled.
8) Consult with an ERISA attorney, who has knowledge in the field of long term disability and ERISA litigation, to answer any questions or for representation.
These are just a few of the steps to take to protect your rights and make it easier for an attorney to decide whether to represent you in your long term disability case. The time to appeal the denial of your long term disability claim can be short, so it is important to do these things quickly. If you do not appeal the denial of the claim it can bar you from the right to sue the plan for your benefits. If you come to an attorney and only have a short time to do the appeal, he/she may not take the case without having the above information to review. The more evidence that you can collect on your own, the more likely it is that you will win your case or that an attorney will take the case and handle and appeal or lawsuit against the long term disability car
Phillip A. Tatlow, Author and Partner at Bollwerk & Tatlow, L.L.C.
