What Happens if the ERISA Appeal is Denied?
If the claimant's appeal to the insurance carrier or plan is denied, the next option may be to file a lawsuit.
The course of a disability lawsuit will depend in large part on whether your claim is governed by ERISA. If it is, the lawsuit may proceed relatively quickly in court. The court may or may not allow the claimant's lawyer to pursue what is known as "discovery," which generally consists of interrogatories, requests for documents, and depositions. Courts historically limit discovery in ERISA cases, but more courts are beginning to understand the role of discovery is providing the claimant with a full and fair review of the claim.
Judges decide ERISA disability claims based on the contents of the claims file and written arguments submitted by the lawyers. In their written arguments, the lawyers typically analyze the relevant case law, the applicable standard of legal review, the facts and circumstances of the claimed disability, and other issues. Afterwards, the judge takes the matter under advisement and renders a ruling in due course. Any party not satisfied with the ruling of the judge may appeal to a higher court.