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If you developed a severe medical condition or disability that prevents you from earning a full-time living, you may be entitled to compensation. If you are covered by an employer sponsored ERISA group benefits plan, you have critically important legal rights. That being said, ERISA claims are highly complex. The big insurance companies are notorious for underpaying and wrongfully denying valid claims. If you have had your application denied, please contact our experienced Menlo Park ERISA attorneys for a free, comprehensive review of your case.
Application: Your Menlo Park, CA ERISA claim starts with you filing an application for benefits with the insurance company. This application needs to be completed thoroughly and carefully, with all supporting evidence included with it, so that you can increase your odds of getting your benefits as soon as possible.
Review: When the insurer receives your claim, the company has 45 days to review your application. After this 45-day period, a decision should be issued. Though, the insurance company can obtain up to two 30-day extensions, should more time be required to assess your case. This means an insurance company can take as long as 105 days to make a decision on your ERISA claim.
Decision: Once the review is completed, you will receive a decision letter from the insurance company. If your benefits are granted, then you should start receiving benefits subject to ongoing reviews by the insurance company. If your benefits are denied, the insurance company is required to explain exactly why that decision was reached, as well as what you need to do next to appeal the ruling.
Administrative Appeal: You will have 180 days to bring your appeal. If you fail to take action, your case will likely be over, and you will not receive your benefits. Do not miss your chance to appeal. When appealing, you need to work with a lawyer who can help you prepare a strong claim that directly attacks the insurance company’s faulty reasoning. You must include additional supporting evidence.
Litigation: In some California ERISA cases, a lawsuit will become necessary. Under ERISA’s process rules, you can only initiate litigation after you have taken your case through the insurance company’s full internal appeals process. It is worth mentioning that any future court that hears your lawsuit will be limited to reviewing the evidence that is already included in your claim file. In other words, you need to ensure that you submit a strong internal appeal to protect your rights in future litigation.
At Kantor & Kantor LLP, our attorneys have extensive experience handling all aspects of ERISA disability case. If your claim was rejected in Menlo Park, California, we can help. To schedule a free review of your case, please call us today at (510) 992-6130 or reach out to us directly online.
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