If the insurer makes an "adverse benefits determination" (meaning a decision that is in some way not favorable to you - such as terminating or denying your benefits claim), ERISA regulations require that you be allowed to submit an administrative appeal to the insurer. The administrative appeal must be submitted to the insurer within a time frame that is determined by the type of benefit for which you are making a claim, and should include all information you can gather in support of your claim. The administrative appeal is VERY important because once the insurer has received you appeal, there is no other chance to submit any new information. The insurer will decide whether to stand by or reverse its original decision based on what you have submitted. If the insurer decides to stand by its original decision to deny or terminate your benefits, your only recourse is usually to bring a case in federal court.
Sometimes people ask us why they should bother with submitting the administrative appeal. Maybe you are sure the insurer will deny the appeal anyway. Or maybe you are in a hurry - administrative appeals take time and money to prepare, and you may end having to bring a lawsuit in the end anyway. Why not bypass all that hassle and go right to court?
The answer is that ERISA requires you to do all required administrative appeals before bringing a lawsuit. If you initiate a lawsuit before completing the administrative appeals, your lawsuit will be dismissed without being heard. While there are a few exceptions to this rule, generally you must submit all required administrative appeal process before going to court.
If you have questions about administrative appeals, you can contact us at the Law Office of Katherine L. MacKinnon for a consultation on your case.
Showing posts with label deadline. Show all posts
Showing posts with label deadline. Show all posts
Tuesday, January 20, 2015
Monday, January 28, 2013
Interested in Converting? Tread Quickly and Carefully!
If you are leaving work for a health related reason - for example medical leave for treatment of an illness, short or long term disability, or other medical reason - it may be imperative to find out about whether you can take your life insurance policy with you when you go!
Usually, if you have life insurance through a group policy at work, when you leave employment you have a right to convert that insurance into an individual policy. This right is guaranteed in the majority of states (see a list of some, but not all, states statutes at the end of this blog post for examples.)
When you purchase a life insurance policy, you are usually required to answer questions about your current and past health conditions, and maybe submit to some type of medical exam. This is so the insurer can decide how big of a risk you are,whether they even want to give you a policy, and how much they want to charge you in premiums. Their investigation of your health is called medical underwriting.
However, when you convert your group policy from work, you do not have to undergo any medical underwriting. You are guaranteed the right to continue your policy, although it will likely be for a higher premium than you were previously paying.
If you are leaving your job for a health related reason, it may be difficult for you to obtain life insurance again because of your medical history. It is therefore very important to find out the costs of and process for converting your group policy to an individual policy. In some states depending on the insurance policy's language, an insurer may not be required to notify you. So it may be the responsibility of the employee to find out whether they can convert their life insurance, and how to do it.
The moral of the story is: be proactive and find out the price and procedure for converting your life insurance policy. Be especially sure to find out the time limit to submit any required premiums and paperwork, since most policies have a very short time frame in which to complete the conversion process. Request the paperwork, even if you are unsure whether or not you want to go through with the conversion, so you have everything you need in case you do decide to convert.
(State statutes regarding life insurance conversion from a group policy into an individual policy: Arkansas, Ark. Code Ann. §23-83-122; California, Cal. Ins. Code §10209(b); Delaware, 18 De. Code Ann. Tit. 18 §3125; Georgia, O.C.G.A. §33-27-5; Illinois, 215 Ill. Comp. Stat. Ann. 5/231.1(h); Massachusetts, Mass. Gen. Laws ch. 175 §134A; Minnesota, 61A.09, subd. 1(h); New Jersey, N.J. Stat. Ann. §17B:27-73; New York, N.Y. Ins. Law §4216(d); Pennsylvania, 40 Pa. Cons. Stat. Ann. §532.7; Tennessee, Tenn. Code Ann. §56-7-2305(c).)
Usually, if you have life insurance through a group policy at work, when you leave employment you have a right to convert that insurance into an individual policy. This right is guaranteed in the majority of states (see a list of some, but not all, states statutes at the end of this blog post for examples.)
When you purchase a life insurance policy, you are usually required to answer questions about your current and past health conditions, and maybe submit to some type of medical exam. This is so the insurer can decide how big of a risk you are,whether they even want to give you a policy, and how much they want to charge you in premiums. Their investigation of your health is called medical underwriting.
However, when you convert your group policy from work, you do not have to undergo any medical underwriting. You are guaranteed the right to continue your policy, although it will likely be for a higher premium than you were previously paying.
If you are leaving your job for a health related reason, it may be difficult for you to obtain life insurance again because of your medical history. It is therefore very important to find out the costs of and process for converting your group policy to an individual policy. In some states depending on the insurance policy's language, an insurer may not be required to notify you. So it may be the responsibility of the employee to find out whether they can convert their life insurance, and how to do it.
The moral of the story is: be proactive and find out the price and procedure for converting your life insurance policy. Be especially sure to find out the time limit to submit any required premiums and paperwork, since most policies have a very short time frame in which to complete the conversion process. Request the paperwork, even if you are unsure whether or not you want to go through with the conversion, so you have everything you need in case you do decide to convert.
(State statutes regarding life insurance conversion from a group policy into an individual policy: Arkansas, Ark. Code Ann. §23-83-122; California, Cal. Ins. Code §10209(b); Delaware, 18 De. Code Ann. Tit. 18 §3125; Georgia, O.C.G.A. §33-27-5; Illinois, 215 Ill. Comp. Stat. Ann. 5/231.1(h); Massachusetts, Mass. Gen. Laws ch. 175 §134A; Minnesota, 61A.09, subd. 1(h); New Jersey, N.J. Stat. Ann. §17B:27-73; New York, N.Y. Ins. Law §4216(d); Pennsylvania, 40 Pa. Cons. Stat. Ann. §532.7; Tennessee, Tenn. Code Ann. §56-7-2305(c).)
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