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Your Timeline for Filing a Long-Term Disability Claim and Appeal

 

If you end up in a situation where you’re unable to work due to a sudden or lingering disability, you may already have benefits provided by your employer, or through a policy you purchased privately.  These long-term disability benefits exist to help ensure you can receive a basic level of income until you’re able to get other benefits or return to work.  However, if you’ve never filed for long-term disability, it’s very likely you aren’t aware of the timelines that matter to your claim.

In this article we are going to help you understand the timelines that must be met by your long-term disability insurer if their policy is bound by ERISA.  We’ll also cover the timelines that you must meet.  First though, we need to talk a little about ERISA.

 

ERISA’s Claim Regulations Are The Rulebook For Your Long-Term Disability Application and Appeal

ERISA is the Employee Retirement Income Security Act of 1974.

In short, ERISA regulates the responsibilities of those managing and administering certain benefits plans; including retirement plans, and in the case of the work we do at Roy Law, long-term disability plans.  Employers bound by ERISA are required to establish and administer an application and appeals process that meets certain requirements.

The simple fact is, providers of claims governed by ERISA must follow a set of rules for evaluating any long-term disability claim for benefits they receive.  Those insurance providers are required to follow ERISA for reviewing and deciding disagreements or appeals of unfavorable decisions.

You can find out more about ERISA here.  You may also want to look at our article, What’s the Difference Between Long Term Disability & Social Security Disability?

 

Initial Long-Term Disability Application

In general, ERISA requires that upon your initial application for long-term disability benefits, your long-term disability insurer has up to 45 days to approve or deny your application.  Your insurer can delay this, with reason, by requesting an extension of up to 30 days.  If your insurer requests this extension they should provide a reason why and specifically identify what they need in order to make a final determination.  If the insurers needs information from you, you have 45 days to respond with whatever information the insurer claims to need.  If you’re unsure how to respond, this is a great point in time to discuss your claim with an ERISA law firm, like Roy Law.

Once your insurer has received the additional information they require, they have no more than 30 days to make a determination.  The ERISA Long-Term Disability Infographic below may help in understanding this process.

Infographic: ERISA Initial Long-Term Disability ApplicationThe shortest path through the initial application process is if your insurer doesn’t need additional information to make a determination.  In that case, you could have a decision in less than 45 days.  However, if there are reasons your insurer needs to delay making a decision, you could waiting several months or more for a determination.  After the determination has been made, if you are denied or find your determination unfavorable, you have up to 180 days to file an appeal.   The process for appealing should be provided by your insurer and be consistent with ERISA guidelines as described in the next section.

 

Appeal to Long-Term Disability Decision

Infographic: ERISA Appeal to Long-Term Disability Decision
If you have received and adverse benefits determination and have requested an appeal of the determination your long-term benefits insurer has 45 days to decide on the appeal.  As with the initial application for your insurance benefits, if the insurer needs it they can have more time to make a determination.  Up to 45 additional days.  But they must provide an explanation of why they need the additional time to make a determination as well as an expected date of when the appeal will be determined.If your appeal is decided unfavorably some plans will allow/require a second appeal prior to further legal action.  Whether your plan requires a second appeal, or your rights to appeal have been exhausted, this is the point where you really need to contact an ERISA law firm, if you have’t already.  To learn more about this, take a look at our article about being denied long-term disability benefits below.

What To Do If You’ve Been Denied for Long-Term Disability Benefits

 

About the Author

In 1998, Chris obtained his law degree from the University of Oregon, and in 1999, he accepted his first job as an attorney with the Washington State Attorney General’s Office. In 2000, Chris entered a private litigation practice in Vancouver, Washington. In private practice, Chris litigated a variety matters including administrative, criminal, real estate, construction, business, and insurance.