There have been gradual changes in the ERISA law which can affect your case in the worst of ways.
The most disconcerting change is many courts refusing to allow subsequent responses to new information submitted by claims administrators with their final appeal of claims. In the parlance used by practitioners such as myself, such behavior is termed "sandbagging." This practice goes against the "full and fair" review process supposedly guaranteed to claimants under ERISA.
Sandbagging conduct by plan administrators allows them to hide the ball and get the final word on appeal without allowing claimants to review or address the newly issued evidence AT ALL. To say that such practice is unfair does not come close to what it really is......CORRUPT. And, by the courts endorsing this practice, it only allows insurers to run rampant over unsuspecting claimants.
For this reason, it is more important than ever to acquire attorney representation prior to appealing a claim denial under ERISA. As many courts are now forbidding subsequent responses to new information contained in final claim denials, it is imperative that the original appeal be as complete as possible in order to be successful.
At this time, success rates in court for ERISA-based disability cases runs about 40%. This does not bode well for claimants and even less so for those who do not file complete appeals to claim denials.
It is important for you to understand that a complete appeal is much more than a letter from your physician, a little internet research, and/or a short demand letter from an attorney who is unfamiliar with ERISA-based disability appeals. A complete appeal from this firm will be approximately 40 pages in length on average and contain hundreds of pages of attachments. These attachments will include information gathered about insurers over the years which is not available to most lawyers. Full medical summarization of claimant conditions from medical treatises and journals will also be included in addition to thoroughly researched legal arguments.
Therefore, at the time of the writing of this article, this firm will no longer accept contingency cases for which a final denial has been rendered in which this firm was not hired to assemble the appeal. The law has changed to the worse and the risk is too great for us to underwrite the risk.
Therefore, please make sure that: YOU HIRE EXPERIENCED COUNSEL PRIOR TO FILING A DISABILITY APPEAL. MAKE SURE THAT THIS COUNSEL HAS SIGNIFICANT LITIGATION EXPERIENCE IN THESE MATTERS INCLUDING COURT DECISIONS. IF YOUR ATTORNEY ONLY SETTLES CASES, IT WILL REDUCE THE VALUE OF YOUR CASE.