The ERISA Claims, Denials and Appeals Process
Employer-purchased or -provided insurance policies are, with few exceptions, governed by the federal law known as the Employee Retirement Income Security Act (ERISA).
If the insurance dispute you are dealing with involves such a policy, you need to know that the ERISA law strongly favors the insurance companies. In fact, because insurers face no penalties for wrongfully denying claims, there is no real incentive for them to pay any claim at all.
What you also need to know is that as a policyholder, your rights are very limited under ERISA, especially as compared with the rights you would have under a privately purchased policy.
Attorneys at Goldstein, Gellman, Melbostad, Harris & McSparran have extensive successful experience helping people throughout Northern California, including San Francisco, Oakland and San Jose obtain benefits under employer plans governed by ERISA. For advice on making your claim, or for help with an ERISA denial and appeal, call us at 415.673.5600
If you have received an ERISA claim denial, you do not have to simply accept it. You can and do have the right to appeal. In fact, with experienced legal help, you can overcome the obstacles ERISA poses and secure the benefits you deserve. However, you have only 180 days in which to file your request for an administrative appeal.
In handling your appeal, our lawyers will take the critical first step of obtaining your administrative case file from the insurer and then carefully review it to make certain it is complete. This is important because in all likelihood, any evidence that is not contained in the record will not be considered during the appeals process.
In addition to handling ERISA denials and appeals, our firm provides proactive advice and services designed to help you prepare a stronger initial claim. This may or may not result in your initial claim being approved by the insurer but, at the very least, it will provide a more solid foundation for your appeal of that ERISA denial later on.
Contact our offices in downtown San Francisco to arrange for an initial consultation.
For information on related topics of interest, see: