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Protecting Your ERISA Claims

If you have become disabled and your disability insurance is regulated by ERISA, there are things you can and should do now to help ensure the success of your ERISA claim.

Read Your Plan — To find out if you are eligible for long-term disability benefits, it is important to obtain the most recent copy of your group disability insurance plan. This may be available on your company's Web site or by contacting your human resources department. Review the summary plan description paying special attention to the definition of disability and any exclusions such as pre-existing conditions.

Keep an ERISA Disability Claim Journal — Keep notes of the times, dates and subjects discussed with your insurance company, your employer and your doctors, Note the progress of your symptoms and treatments. And keep copies of any correspondence.

Work with Your Physician — The success or failure of your ERISA claim depends to a great degree on the evidence your physician provides and how his or her description of your condition meets the plan's definition of disability. It is important that your doctor is a specialist in the treatment of your specific condition and understands and is willing to participate in the disability process. Our attorneys are happy to assist you in finding a doctor or helping you or your physician navigate the disability system at any stage of the process.

Filing Your ERISA Disability Claim — Obtain and complete the appropriate forms from your insurance plan or from your employer's human resources department. Your doctor will need to complete a portion of the form, too. It is important to include additional information, such as your medical records, statements from co-workers or family members, excerpts from your claim journal and other relevant information about your disability. Our ERISA lawyers can help you build your claim file and enhance your chances of success.

Get a Copy of your Claim File — It is important to see the information on which the insurance company will base its decisions. Your claim file will contain the information you and your doctor provided as well as correspondence between your employer and the insurance company. Your file may also contain internal insurance company communications articulating the basis for the denial or interpretations of the medical evidence which you may refute during your appeal.

To learn more about the ERISA claim process and how we can help you avoid the pitfalls and obstacles that could result in a claim denial, please contact Pillsbury & Coleman, LLP. You may call our office at 415-655-1549 or send us an email. From offices in San Francisco, we represent clients in disability claims throughout California.