What is the Timeline for a Claim Under an ERISA Long-Term Disability Plan?

What is the Timeline for a Claim Under an ERISA Long-Term Disability Plan?

The Employee Retirement Income Security Act of 1974 (ERISA) governs most long-term disability benefits offered by employers. While not every claims process for disability benefits is exactly the same, ERISA sets certain time limits on different aspects of the claims process that insurance companies must follow.

According to 29 C.F.R. ยง 2560.503-1(f)(3), you should receive a decision on your claim for long-term disability benefits within 45 days of filing your claim. However, the insurer may request an extension of up to 30 days to make its decision on your claim, so long as it notifies you of the request for an extension and explains why it is making the request. (It is actually quite unusual for an insurance company not to ask for an extension when reviewing an application or appeal). That notice also should let you know when the insurance company will make a decision on your claim. If at any point the insurance company requests more information from you about your claim, you have 45 days in which to respond to its request. Once you have provided the requested information, you should receive a decision on your claim within 30 days or by the date stated in your insurance plan, whichever comes first.

If the insurer rejects your claim for long-term disability benefits, you have 180 days from the time that you receive the denial notice in which to appeal the denial of benefits. Most plans require an appeal, before seeking legal action, while some plans allow for a voluntary appeal. Once you submit your appeal, you should receive a decision from the insurance company within 45 days. In some cases, the insurance company can request as much as an additional 45 days to process your appeal, so long as it notifies you and explains the reasons that it needs more time.

If the insurance company denies your appeal, some plans provide for a second appeal. If your plan does not require a second appeal, most insurance companies will entertain a voluntary second appeal, but they are seldom granted. If you receive another denial of benefits following a second appeal, then you must file suit in court in order to further appeal the denial of benefits. As a general rule, you must file suit in the state of California within four years of the denial of your appeal, keeping in mind that some ERISA-governed insurance plans may attempt to require a shorter timeframe in which to file suit or consider the timeframe to begin at an earlier point than you might expect. Under claims for benefits filed after January 1, 2018, however, your final denial of benefits from the insurance company must advise you exactly how long you have to file suit in court. Nonetheless, filing a lawsuit regarding the denial of disability benefits should occur as quickly as possible following the denial of your appeal.

As you can see, the long-term disability claims process can take several months or more, depending on certain factors. No matter what type of illness, medical condition, or injuries forms the basis for your ERISA claim, the attorneys at Bonnici Law Group have the skills and knowledge that you want and need to help you with your ERISA claim. We know how crucial this claim can be to you and we are here to represent your interests against whichever insurance company is involved. For legal advice about your claim, please contact Bonnici Law Group at 619-259-5199 or help@bonnicilawgroup.com.

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