ERISA, or the Employee Retirement Income Security Act, is a state law that sets the minimum standards for employer-sponsored insurance. The majority of the US life insurance plans offered by employers follow the ERISA plan. Even though ERISA offers many defenses, many beneficiaries are denied their rightfully deserved payouts. This often happens because insurance companies are for-profit organizations that need to take in more money than they pay.
ERISA laws are complex and require many legalities to be followed. Therefore, we've gathered the most important information you must have when you plan to contest the denied life insurance claims after the death of your loved ones.
Challenging the Denial of Life Insurance Claim
If your claim has been denied, you have the right to appeal the insurance company's decision as a beneficiary. You must file an administrative appeal to the insurance company before filing a lawsuit to the federal court within the given time frame, typically 60 or 180 days. You're legally limited to only one appeal. Failure to file the appeal in time can result in your court action being barred forever. Best to retain a life insurance attorney to handle the appeal or you may find yourself with a serious problem.
Before you begin your ERISA appeal, make sure that you:
- Carefully review and understand the insurance company's denial letter
- Gather any additional evidence for your appeal
- Don't miss out on the filing deadlines mentioned in the denial letter
- Have a life insurance attorney file a comprehensive appeal on your behalf
The ERISA appeal procedure is time-sensitive and relies on the strength and quality of your supporting documentation. If your life insurance attorney files a comprehensive legal brief, the process can become considerably easier. The steps included in filing an appeal are as follows:
- Appeal the denial of life insurance benefits, our life insurance attorneys submit a 200 page legal brief.
- If the administrative appeal gets denied, file a lawsuit in federal court.
- File litigation against the insurance company for "breach of fiduciary duty," which refers to its failure to maintain its commitment to act in the best interests of its beneficiaries.
After your appeal goes to the federal court, you won't be able to introduce any fresh evidence. Once your case gets to trial, there are no jurors exercising power over the decision. A judge will consider both your initial claim and your appeal before reaching a final decision on your payments. Your appeal must be strong and include as much evidence as possible.
Obstacles in Filing an ERISA Appeal
Your appeal is critical in changing the initial decision and claiming the benefits you're entitled to. Some obstacles that you might face during this process can include:
- Failure to gather a complete record of your claim
- Missing an important appeal deadline
- Forgetting to add information in the lawsuit which waives your right to include it once your appeal is denied
- Giving a verbal statement of appeal to the insurance company and accidentally losing your rights
If you want to win your ERISA insurance claims successfully, don't hesitate to contact an attorney since many insurance policies have contractual limitation periods. The timeframe to go to court is considerably shorter than the time a person would generally have to file a lawsuit, and the courts enforce these policy provisions.
Hire a lawyer that fully understands these requirements and will defend your rights by filing court documents on time.