When a New Jersey resident is filing an insurance claim under the Employee Retirement Income Security Act, there are important facts to remember. This is true whether the case is being negotiated or there is a trial after the claim is being disputed or was denied. Understanding the claims and appeals processes is not a simple matter, and it would be a mistake to move forward without having assistance from an experienced attorney.
The ERISA claims process has nuances that must be considered. The preparation of the filing, ensuring all the information is correct and other basic factors can be just as important as the issues that led to filing. Filling out the claims forms accurately, providing all the necessary medical evidence and documentation and more are key. These documents are generally acquired from the insurance company or the employer’s human resource department.
The medical records must be acquired from the doctor, as well as other information regarding the medical issues and why the person either cannot work or is limited at work. After the claim is filed, the insurer is required to decide on the case in a certain time frame and notify the claimant. When there is a denial, reasons must be provided as to why that is the case. The insurer must tell the worker that they have the right to appeal.
When appealing a denied claim, the filing must be done within 180 days from the date the denial notice was received. The claimant has the right to introduce more evidence to help the case while the appeal is in progress. If evidence is not submitted during the appeal, it cannot be weighed if it is necessary to pursue litigation.
With ERISA, the idea is to protect employees if there is a disability and long-term care is needed. When the claim is denied and an appeal is necessary, the result of the case can have a massive impact on the person’s life. Legal help is crucial in an ERISA filing and the appeals process. You should contact a lawyer immediately to help with a claim or appeal.