Tips to Help You Win Your ERISA Disability Appeal

The Employee Retirement Income Security Act (ERISA) is a federal law from 1974 that governs how employers provide benefit plans to employees. If your request for disability benefits through your employer got denied, you need to know the rules that you have to follow when you challenge that adverse decision. If a court can find a procedural reason to dismiss your lawsuit without having to look into the substance of your claim, they will likely do so.

Another way of saying this concept is that, no matter how devastating your disability, your case can get thrown out of court if you missed a deadline or did not follow the proper procedure before taking your case to court. If you work with a Texas disability attorney from the beginning, you can avoid the landmines that can stand between you and the compensation you deserve. Here are some tips to help:

Get Your Roadmap

When you eventually end up litigating your ERISA disability appeal, the court will check to see if you followed the rules of your employer’s disability insurance plan (plan). Let’s say that the plan requires you to appeal the denial directly to the disability insurance company first before filing a lawsuit.

If you did not follow the rules of the plan and instead went straight to court, the judge could throw out your case for failure to exhaust your administrative remedies. By the time that you reach that point, several months might have passed.

Disability insurance plans tend to have short deadlines, like 10 days or 30 days to file an internal appeal after a denial of benefits. When the court dismisses your case because you skipped the internal appeal step, it is likely too late to go back and file the internal appeal. Case over.

We realize that this outcome is harsh, which is why we are warning you about that possibility. The first step you should take when you want to apply for ERISA disability benefits is to get a copy of your employer’s ERISA disability plan. That way, you can avoid making mistakes on your application that could lead to a denial of benefits.

Obsess Over the Deadlines

In many other situations, deadlines are more of a suggestion rather than a hard line in the sand. Unfortunately, when dealing with insurers, ERISA disability claims, and court cases, time limits can make or break your case. Missing a deadline by one day can cost you the right to receive any compensation at all, no matter how severe your disability.

Understand the Difference Between the Definition of Disability for an ERISA Disability Claim and a Social Security Disability Insurance (SSDI) or Supplemental Security Income (SSI) Claim

These three types of disability benefits do not use the same standards for determining what is a disability. You might qualify for SSDI disability benefits but not for ERISA disability benefits. Also, the rules, forms, appeals process, and deadlines are different for these programs. Even though ERISA is federal law, and a federal agency, the Social Security Administration (SSA), runs the SSDI and SSI programs, do not make the incorrect assumption that they have the same rules and procedures.

We understand that these laws and appeals processes can be confusing. You do not have to face this situation alone. A Texas disability attorney can guide you through your ERISA disability appeal. Contact our office today.