Dealing with long-term disability insurance is rarely simple. This is especially true when it comes to filing an appeal – a process that can feel like endless paperwork entangled in many hard-to-remember rules.
However, there is one important element that anyone appealing a long-term disability decision should be sure to do. If done right, it can set them up to have the best chance at success not just immediately, but down the line.
Understanding the appeals process
Most employer-offered long-term disability insurance must adhere to a federal law known as ERISA (the Employee Retirement Income Security Act of 1974). Under ERISA, appeals have to go through certain stages.
After an initial denial, the claimant first has to appeal the insurance provider directly by following the procedures laid out in the plan. You’ll generally have 60 days (sometimes more) to resubmit your case with whatever additions you believe might result in a different decision. Only once that internal appeals process has been exhausted can the claimant file a lawsuit.
What they often don’t tell you, however, is that the choices you make during the internal appeal can have a dramatic impact on your case if it ever goes to court.
This is why it’s important to stack the record.
Stacking the record: The basics
If your internal appeal is denied, you can opt to pursue a lawsuit in federal court to try to reverse the decision. However, once you reach this point, you will most likely not be able to submit any new evidence. Instead, during the hearing, the judge will very likely review only what you had submitted to the insurance company during the internal appeals process.
That means the decisions you make during the internal appeal are crucial.
Stacking the record is a way of planning ahead. Basically, you want to put as much relevant evidence as possible in your internal appeal file. This evidence should be tailored to not only convince the insurance provider to change its mind, but also be framed in a way that is persuasive to a federal judge down the line.
This is not an easy thing to do. Not only does it require an intimate understanding of federal law, but you have to know what judges look for and how to present your case in the most effective way possible.
That’s why it is vital to get an attorney on board as soon as you receive the first denial letter and are thinking about an appeal. A lawyer can help prepare for whatever happens to your case in the future, setting you up for a chance at success.
