Tips to File ERISA Claim

Hi, I’m Attorney Nathan Bax here at the Foster Law Firm and today I wanted to give you some tips about how to file your ERISA claim. Now, let me start by saying that this is not legal advice, this is just some general information about claims and that each person’s circumstance is unique so just call us if you have some questions or concerns. Secondly, by watching this video it does not create an attorney-client relationship, this is simply an advice video that we are going to use on our video blog.

Now, what I’m going to talk about today, in general terms, is a short term and long term disability claim. However, a lot of these tips will apply to any type of ERISA claim be it health insurance, life insurance, or retirement.

  1. Now, the first tip is to request, from your employer, the claims forms. A lot of folks will go directly to their short term and long term insurance carrier and a lot times that does work, but technically your employer should provide you those forms if you having trouble getting it from the insurance company. Now a lot of insurers now days have gone from written forms to on-line or telephonic. So, be aware you may have to go on-line to make your claim or call a 1-800 toll free number and make the claim that way. Now if you request the claims forms they generally have 30 days to provide those to you. So, keep track of when you made the request and make sure that you receive it within 30 days. If you don’t, call an attorney and they should be able to help you out.
  2. The next tip that I want to tell you about is to make sure that the insurance company gets everything that they need. The quickest way to get a denial is to not provide the requested information. When a short term and long term disability insurance claim is made then the insurance company normally wants a list of your doctors, list of your medication, a lot of details like this so they can begin processing the claim. If you don’t provide those to them in a timely manner that is a quick way to get a denial and it’s certainly something that is avoidable so try to get them everything they need regardless of how many times they request it, just make sure that they get what they are requesting and that will give you the best chance of getting your claim approved.
  3. The third point is to make a copy of everything. My next several points are all going to relate to this making sure that the insurance company gets everything they need to review the claim. Now a lot of doctor’s offices or the insurance company use, and I do as well, use fax machines. Those are somewhat of an outdated technology and they are somewhat unreliable.   So any time you send anything to the insurance company keep a copy of it because if they later come back and say well we didn’t receive that then you’ll have it right there to submit again.
  4. Tip no. 4 is to keep a proof of sending it and that they received it. I would recommend that if you do fax it keep a copy of the fax confirmation receipt. If you can use email you can always save a copy of that as well and if you mail anything then always send it certified or some other way that gives you a receipt that it was received. In essence, what you just really want to do is create a paper trail to demonstrate that if the insurance company says that they didn’t receive something you can prove that they did get it and that you sent it in a timely manner.
  5. The last and, perhaps, the most important tip is to help your doctor. Doctors, especially in our present time, are flooded constantly with requests from insurance companies, lawyers on both sides, they are just swamped with this stuff, this ministerial insurance claim work that has very little to do with their actual treating of the patient. A lot of doctors can get frustrated or overwhelmed or in general just fed up with this process. So be aware of that. I often recommend that you contact your doctor’s office, give them a heads up that you are pursuing your private insurance disability claim and that they’ll likely get requests from your insurance company. Now what you can do is ask the doctor, say “hey, if you do send to the insurance company would you save me a copy and I’ll come by and pick it up” or you can tell your doctor’s office if they prefer that any time they get a request for anything they just give it to you and you can submit it for them. That gives you the control over the claim and the ability to ensure that the insurance company received whatever it is that they are trying to get, particularly your medical records and doctor’s opinions, that’s going to be the most important thing.

Now, if you follow these 5 tips and after all of this you’re still getting the run around, it’s been a significant amount of time, and you’re not getting anywhere with the insurance company, that’s when you might need to contact a lawyer. I normally try not to be retained during the initial claims process because a lot of folks can get approved without an attorney and that is obviously a good goal because you don’t have to pay for my services for something you could have done on your own. But if it does get to the point where it’s been a significant period of time, 2 or 3 months out, and you still don’t have your benefits, that’s probably the time to start contacting a lawyer. Secondly, like I already mentioned, if you can’t get the claims forms to start the process contact an attorney, there’s normally a 30 day time period to do that. So, the main thing that you have to remember is keep track of these deadlines. This is a very important process, you just want to make sure that nothing gets dropped. The last thing is if you get a denial that’s when you absolutely need to contact an attorney whether it’s me or any other attorney in the country. If you get a denial letter contact an attorney. The denial letter will likely say that you have a right to appeal that decision. I strongly recommend that you don’t appeal that on your own. I’ll do some videos on that later, but for today’s purposes, just know that when you get that denial letter that’s absolutely the time to get an attorney. So, we’re here to help, if you have any questions always feel free to contact me.



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