Appeal Denials and Federal ERISA Litigation

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An administrator must give notice of its decision on the appeal, setting forth the basis for a denial, again with 45 days, or 45 plus 30 if necessary for reasons beyond its control. Once the administrator makes a final determination and the claimant has ‘exhausted’ all remedies available under the policy, the claimant can bring an action in federal court … Read More

Applying for Disability Under an ERISA Group Policy

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Plan administrators have the authority under the ERISA statute to review initial ERISA long term disability claims and to deny claims. There is typically a procedure for submitting an initial claim that requires applicants to obtain attending physician reports from health care providers, fill out activities of daily living forms, sign authorizations so that the administrator can gather documents and … Read More

Plan Sponsors, Participants and Beneficiaries in ERISA

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Plan sponsors, participants and beneficiaries in ERISA disability.  An ERISA disability plan is not simply a contract that a person enters into with an insurer or other entity. Rather, it is a plan established by an employer or other entity and offered to a group of employees who may choose to join the plan or not. Although the employees may … Read More