Deadlines You Need to Know for Long-Term Disability Claims
Navigating the legal process is a very complex undertaking, and one of the reasons for this complexity is the deadlines. From statutes of limitation to deadlines to file an appeal, legal deadlines are numerous and heartbreaking if not met, sometimes resulting in the loss of the right to file a case. Similarly, engaging with an insurance company as part of filing of a Long-Term Disability (LTD) claim is also full of key deadlines. Retaining the services of an experienced disability benefits attorney can to ensuring that deadlines are not missed. As an example of the unfortunate consequences of missing a deadline, a court granted a motion to dismiss a claimant’s claim due to the fact that she was time-barred from filing suit.
ERISA
Although anyone can buy LTD benefit insurance policies, many companies provide them to employees as part of their benefits package. In these cases, these LTD policies are governed by ERISA, which is under the auspices of the Department of Labor. Any individual who has suffered a long-term disability which prevents him/her from continuing his/her employment is eligible to file a claim with the company-sponsored insurance company.
Deadlines of Note
Initially, it is important to understand when the LTD claim must be filed. For this, reference to the LTD insurance policy is a must, as it will usually detail, in a section potentially marked as “Notice of Claim” or something similar, when a claim must be filed in relation to the onset of the injury. While most insurance companies will list an actual date certain (i.e., 60 days after the onset of the debilitating injury), it is important to understand that some policies may be intentionally vague, and state that the claim must be filed “as soon as reasonably possible.” In such situations, it is advisable to speak to an experienced attorney, as they can provide the potential claimant with the most appropriate response to such a vague requirement.
Once the claim has been filed, ERISA provides some deadlines, applicable both to the insurance company as well as the claimant. The following are some of the more important deadlines:
- The insurance company has 45 days from the date of the initial claim for benefits to approve or deny the claim.
- However, the insurance company can request an extension of this for up to 30 days, for a total of 75 days from the date of initial filing. If the insurance company does request this extension, they are required to state the specific reasons why, as well as a specific identification of what they need in order to make a final determination.
- If the insurer requests additional information from the claimant, he/she has 45 days to provide this information to the insurance company.
- Once the additional information is received, the insurance company has 30 days to make a determination on the claim.
- If, upon determination, the claimant is denied or otherwise believes the decision to be unfavorable, he/she has 180 days to file an appeal. As illustrated in the case noted above, this deadline is hard: Failure to file an appeal within 180 days will extinguish the matter, and no further against the insurance company is permitted.
- Upon filing the appeal, the insurance company has 45 days to make a decision, with a possible extension of up to 45 days more.
- If the appeal is decided unfavorably, some plans permit the possibility of a second appeal prior to further legal action. Again, like the first appeal, if a second appeal is required prior to instituting legal action, this deadline must be met or the claimant forfeits his/her right to court review.
Get Help
If you have recently submitted, or are considering submitting a claim for LTD benefits, and are curious about the process, contact a Jacksonville long-term disability attorney as soon as possible. The legal team at Farrell Disability Law has years of experience in advising their clients in every aspect of the LTD claims process. We will be able to counsel you about what you need to do to give yourself the best chance at a successful LTD claim. Contact our office today.
Resource:
beckershospitalreview.com/payer-issues/judge-grants-aetna-s-motion-to-dismiss-disability-benefits-lawsuit.html
https://www.mydisabilitylaw.com/filing-for-long-term-disability/
