There
are three common times when you should think about involving an attorney in your ERISA
employee benefits dispute or claim: (1) when submitting an application for
benefits, (2) after the denial of benefits, and (3) at the commencement of
litigation. Here is why you might choose to retain an attorney at any one of
these times.
You
might decide to hire an attorney to submit your application or claim for
benefits. This is a good strategy if you have a complicated situation or issue
that may affect your application. One example might be if you are applying for long-term
disability benefits after being terminated from employment or quitting from
your job. Another example might be if your disabling condition is complicated
your application for disability benefits may require some explanation as to why
you can no longer perform you job. Applications are time consuming and
complicated, so sometimes people hire an attorney to handle the application
because he or she does not have the time or energy to devote to making sure the
insurer receives all the information necessary. As long as your benefit plan is
governed by ERISA, you will be allowed a chance to appeal any decision made by
the plan administrator that is adverse to you, so many claimants choose to
apply for benefits on their own and then hire an attorney only if they are
denied.
The
most common time individuals hire an attorney is after he or she has had a pension,
life insurance, or disability benefit denied. The attorney can then submit an
administrative appeal for the claimant. An administrative appeal is a written
appeal to the plan administrator explaining why the decision to deny benefits
was wrong, and submitting any new evidence in support of the claim. An
administrative appeal is VERY important, because once it is submitted you are frequently
no longer allowed to submit any new evidence to support your claim to the
insurer. Generally, it is best to consult an attorney when submitting your
administrative appeal, so you can be sure the evidence in the administrative
record (everything submitted to the plan administrator by you, and everything
the plan administrator gathers or creates on its own in regards to your claim)
is as complete as possible so the insurer can make a full and fair review of
your claim for benefits.
Once
you have completed all your administrative appeals, the only option to pursue
your case further is usually to bring a lawsuit in federal court. At this
phase, you should almost always hire an attorney to represent you in your case.
ERISA cases have complex legal issues like how much deference should be given
to the insurer’s decision. It is best to have good legal representation once
litigation begins.
