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.