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When you receive a benefit denial letter, you must exhaust your administrative remedies before you are able to file a lawsuit. Exhausting your administrative remedies means you have to request review of that denial to the plan administrator or insurance company in order to convince them to pay your benefits. An effective appeal is more than just writing a letter and stating your disagreement with the claim denial. Components of a successful appeal are multifaceted, and over the years, we have gained the expertise in understanding what evidence the insurance company needs to approve a claim. We work with you to gather and submit the relevant information in a timely and effective manner. We have a high success rate of getting insurance companies to overturn their claim denials.
At Kantor & Kantor LLP, our focus is on representing individuals with denied benefit claims under the Employee Retirement Income Security Act (ERISA) law. Because we focus on this area of the law, we understand fully how to gather and develop the pertinent evidence and build your best case. You are suffering from a disability and should be focusing on your health; we focus on demonstrating the true extent of your disability so you get the income you need to move forward.
The letter you receive from the insurance company explaining the decision to deny your claim should also state the time frame you have to send in an appeal. For disability benefit claims, you have only 180 days after receiving your denial letter to send in a written request for review of the claim denial. It is important that you contact us when you receive the claim denial letter, since we need as much time as possible to put together a comprehensive and thorough appeal letter.
One of the lesser known nuances of an ERISA benefits claim is that the information submitted or generated before the end of the appeals process is often the only evidence a reviewing court will consider when determining whether you are entitled to benefits. The term “Administrative Record” describes all of the information that the insurance company receives or generates before it issues a final decision letter on your claim. If the insurance company or plan administrator denies your request for review (also referred to as your appeal), the court will review the Administrative Record and decide whether the insurance company made the correct decision. As such, your appeal is arguably the most important aspect of your benefit claim. Putting together a strong appeal includes components such as:
The team at Kantor & Kantor LLP works determinedly to put together a strong appeal for you. Our goal is to get your claim paid before filing a lawsuit. However, if a lawsuit is necessary, our litigators know how to best resolve or win your claim in federal district court.
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As the situation regarding COVID-19 continues to develop, we want you to know that we remain open to serve clients. In order to serve at the highest level, we have upgraded all of our attorneys and staff with work-from-home capabilities. Because our services normally involve little or no contact between clients and staff, the risk of person-to-person transmission is low. However, if you need to adjust or reschedule an appointment, we are happy to work with you to do so. Please contact our office if you have any questions.