ERISA, or the Employee Retirement Income Security Act, is a federal law that governs most employee-sponsored long-term disability benefits policies and claims. There are a variety of regulations that apply to these policies under ERISA, including how they process and respond to claims for benefits.

For example, ERISA sets forth strict deadlines for you to appeal a denial of long-term disability benefits and for your insurer to respond to your claims and appeals. You have 180 days after you receive a denial of benefits in which to file an appeal. Failing to meet this deadline can result in a waiver of your appeal, meaning that you can no longer pursue your claim through an administrative appeal with the insurer or by filing a lawsuit in federal court.

ERISA subjects the insurer to deadlines, as well. Once you submit an appeal, your insurance company has 45 days in which to decide your appeal. If there are special circumstances in your case, your plan can advise you in writing that it needs an additional 45 days in which to decide your appeal. After a total of 90 days, then the insurer must decide your claim. A plan can have a two-tier administrative appeals process, but it cannot require more than two administrative appeals before you can take the matter to court.

ERISA also limits the relief that you can seek in an appeal in federal court and the evidence that you can present to the court. You are not allowed to seek damages for bad faith or pain and suffering in an appeal from the denial of long-term disability benefits claims. Likewise, the only evidence that the court will consider on appeal is the evidence that you presented to the insurer when it made its final decision about your claim – whether you appealed or not. Even if you have new evidence in support of your claim after your last appeal was submitted, you normally cannot submit it to the judge to consider in a federal court action seeking long-term disability benefits. Bonnici Law Group provides client-focused representation throughout the ERISA claims process. We are here to consider the evidence in support of your ERISA long-term disability claim, evaluate your claim, and develop the strongest and most effective strategy for fighting any denials of coverage that you may receive. Allow us to handle your legal needs while you focus on your physical and emotional health. Contact the ERISA long-term disability attorneys of Bonnici Law Group at 858-261-5454 or help@bonnicilawgroup.com.