ERISA establishes various deadlines for filing for long-term disability claims and appealing denials of long-term disability benefits. Although the COVID-19 state of emergency has suspended some of these deadlines until 60 days after the national state of emergency ends, you should still be aware of the applicable timelines and how they can impact your LTD claim.
First, your LTD insurance policy will contain a deadline for you to apply for LTD benefits. You typically must apply for benefits within 30 to 90 days of the date when your disability first made you unable to work. If you do not meet this deadline, you may not qualify for benefits. However, these deadlines for filing claims varies substantially from one state to the next, and from one policy to the next. State law typically applies in determining the statute of limitations or legal deadlines for filing a claim. Still, the insurance plan itself also can contain a statute of limitations for claims under the plan.
Once the insurance plan receives your claim, they generally have 45 days to either approve or deny your claim. However, ERISA does permit insurance plans to obtain several extensions, including an initial 30-day extension, if the insurance plan could not complete its investigation into the claim. If the plan asks you for additional information about your claim, you then have 45 days to respond. Then, if the plan still needs more time to investigate, they can request a second 30-day extension.
Likewise, suppose you receive a denial of your claim for LTD benefits. In that case, you generally have 180 days from the date of your denial to submit an administrative or internal appeal of the denial with the insurance company. Missing this deadline can be fatal to your claim, in that you will not be able to pursue your claim any further.
Once you submit your appeal, you must participate in the review process and submit additional evidence as requested. The insurance company then typically must provide a decision on your appeal within 45 to 90 days. If you receive another denial of your appeal, then you will have 180 days from the date of that denial notice to file a lawsuit in federal court challenging the denial.
If you have developed an illness or suffered an injury and cannot work, you may greatly benefit from calling us today and getting the advice you need. Bonnici Law Group has the experience and knowledge that is invaluable when pursuing a long-term disability claim. When you need answers, contact Bonnici Law Group today at 619-259-5199. As we focus our efforts on personal injury cases involving bicycles and long-term disability claims, we know how to protect your rights and build a strong demand for compensation in your case.