When you file for long-term disability benefits under the Employee Retirement Income Security Act (ERISA), you need to submit a detailed and comprehensive file to the insurance company in your initial claim. Insurance companies are notoriously difficult when it comes to approving these claims, making it even more important to put your best foot forward.
If your claim is denied, you can add evidence, but you can only do so up to a certain point. Under ERISA, you can typically submit additional evidence during your internal appeal, but once the appeal is decided and the case moves to federal court, courts generally limit their review to the evidence already in the administrative record. Your legal team can help with filing your initial claim, given what is at stake.
Evidence That Is a Part of Your Initial Claim
Typically, when you submit your initial claim for long-term disability, you would include the following in the file:
- Personal statement
- Statement from your doctor
- Medical records
- Occupational evidence
- Functional capacity assessment (not required, but sometimes helpful)
You Can Add Evidence for the Appeal File
If the insurance company denies your initial claim, they will need to give you a reason why. ERISA gives you the right to file an appeal, but you must go directly through the insurance company first. Usually, they assign a different group within the company to review the initial decision that was made.
In some cases, their reason may be something that you can address with additional paperwork. For example, if the insurance company claims that they do not see evidence of a disability, you can submit additional medical information from your doctor that can prove that you are disabled. The same thing goes if the insurance company says that you have a pre-existing condition.
You Cannot Add Evidence After an Appeal
There is a point where you can no longer add evidence to your ERISA claim. The initial appeal is where you must build your case. Although you may think that the insurance company will not treat your appeal fairly, you must make every effort to build the strongest possible file at this stage of your case.
If you do not win the initial appeal, you will need to take your case to federal court. There, a judge will make a decision about whether the insurance company made a mistake in denying your claim. Usually, you do not get to add any evidence to the file that the insurance company considered during your appeal once the administrative record is closed. You may need to file a motion to add to the record, and judges do not often grant it.
You should speak with an ERISA long-term disability lawyer early in the process because it can be too late to correct anything missing in your file once you have filed your initial appeal.
Contact a Houston ERISA Disability Lawyer
For help with your disability case, whether it is your initial claim or appealing a denial, speak to a Houston ERISA disability attorney at Raval Trial Law. When you schedule an appointment to speak directly with an attorney at Raval Trial Law, we will take the time to listen and explain what you need to know. Call us today at (713) 324-8118 or submit our online form.
