Important Things to Understand about the ERISA Process

Attempting to recover health related benefits under ERISA laws is a complicated legal matter. Because factual circumstances differ, as well as ERISA policies, it is a good idea to consult disability attorneys in Augusta for advice regarding your specific matter. The following will provide a general overview of how the process works to make a legal claim based on ERISA law. Also, it includes some helpful advice to make sure you do not preclude a judgment in your favor.

Procedures for Filing an ERISA Action

Before you are able to file a legal ERISA action in federal court, you must make sure that you follow the required procedures. You will have no chance of success in court if the proper procedure was not followed.

First, you must make sure to carefully consult your policy and file your claim with the insurance company. The insurance company will decide whether or not it will pay the benefits. If they refuse, then you have the right to appeal the decision. You must appeal the decision in accordance with the timeline and deadlines set forth in the refusal letter provided by the insurance company. Failure to comply within these times can bar your claim.

Once you receive a refusal letter, you should immediately request in writing from the insurance company, a copy of your policy and claim file. These items are extremely important to have when you file your appeal. In most instances, the court will only review these documents.

Filing an Appeal in Court

The next step is filling your appeal in federal court. You do not get a jury trial. A major issue in most cases is that your policy often includes what is called a “discretionary clause,” which gives the insurance company wide latitude to deny your claim. However, legal defenses exist that you can present, depending upon your circumstances. Most disability attorneys in Augusta can advise whether any of the defenses might be available in your case.