The Employee Retirement Security Act of 1974 governs various aspects of the benefits claims process in most employer-sponsored long-term disability insurance policies. Part of these procedures include deadlines for plan administrators to make decisions on claims for benefits. Plan administrators also have deadlines for them to review and make decisions on appeals that individuals may file after receiving a denial of their claims.

All employee benefits plans that are subject to ERISA must establish and maintain reasonable claims and appeals procedures. Generally, plan administrators have 45 days in which to make initial decisions on claims for benefits. If they deny a claim, and the claimant appeals, the plan administrator then has another 45 days in which to make an administrative decision on the appeal.

Nonetheless, when circumstances beyond the control of the plan administrator require an extension of time, ERISA does permit extensions. More specifically, plan administrators have up to two 30-day extensions for deciding initial claims. They also have one 45-day extension available for determining appeals from the denial of benefits.

The failure of plan administrators to adhere to these deadlines can have adverse results for them. Some courts have held that when plan administrators fail to meet mandatory deadlines for making decisions under ERISA, they fall out of compliance with the statute. As a result, when the federal court reviews the plan administrator’s denial of benefits, it will use a de novo standard of review rather than the far more deferential “abuse of discretion” standard of review. This standard of review can give claimants a better chance of success on appeal, as the court need not give substantial deference to the plan administrator’s decision.

Long-term disability claims are complex matters that require intensive knowledge of ERISA laws and regulations. As a result, you will need experienced legal representation and advice to pursue an ERISA-governed disability claim. Bonnici Law Group is a law firm focusing on ERISA long-term disability benefits and bicycle injury cases in San Diego, CA. When you need effective legal representation, contact Bonnici Law Group at 858-261-5454 or email us at help@bonnicilawgroup.com.