ERISA LAW BLOG

Almost every day, I’m asked by potential or current clients, “Do I need an attorney for the appeal process?”  Invariably, that answer is “Yes.”  While the insurer or your claims person from the insurance company may tell you that you do not need an attorney and that if you simply submit your own appeal they will approve it, such a statement is patently false.  The appeal is, perhaps, the most important step in the entire process because that is our only chance to establish the merits of your claim.  During the appeal process, we have the right to examine every single document that the insurer has that has anything to do with you.  We then have the opportunity to respond with whatever evidence we choose to submit.  In other words, it is the last chance where the plaintiff (you) controls the process.  Once the appeal is complete and a final denial has been issued then the administrative record becomes sealed, likely forever.  There are practically no situations where the record would be reopened unless a Judge orders a remand or rules for the plaintiff.  Therefore, anything not submitted during the appeal process cannot even be considered by myself, as your attorney, or the Judge.

Further, the appeal involves complicated deadlines.  If any of these deadlines are missed or you fail to submit the proper document within such a deadline, then that gives the insurer the opportunity to issue the final denial letter, again, sealing the administrative record and blocking the submission of further evidence.  All too many times I have talked to clients who are told by the insurance company that all they need to submit is one little thing.  The potential client will do so and the insurance company, because the individual did not cite to the proper ERISA statute or use the proper language, then turns around and issues a final denial letter, thereby ruining the merits of the plaintiff’s case.  I cannot even count the number of clients I have had to turn down over the years that try to do the appeal on their own and permanently ruin their case.  Unfortunately, those individuals, due to the extremely unfair nature of ERISA claims, could not file a lawsuit and had to walk away with absolutely nothing.

At the Foster Law Firm we pride ourself on trying to take every case that we possibly can.  We do not consider how large or small the value of a case is to handle an administrative appeal.  Our hope is to help everyone get the benefits that they deserve.  If you have any questions about any of the above, please do not hesitate to contact me and I would be happy to discuss and answer whatever that I can.