When you file a claim for long-term disability benefits from your employer-sponsored benefits plan, it may take some time before you receive a decision. Plans governed by the Employee Retirement Income Security Act of 1974 (ERISA), which includes most employer-sponsored plans, have deadlines that insurance companies must follow in processing claims for benefits. Insurers have 45 days in which to consider an initial claim, but they can request an extension of that period by another 30 days if necessary. Plus, if the company requests additional information from you, you will have an additional 45 days in which to provide that information. All in all, it can take at least a few months before you even receive an initial decision about your claim for benefits.

While your initial claim is pending, however, you can continue to submit new or additional evidence in support of your claim to your insurance company. For example, if you are approved for Social Security disability benefits during that timeframe, you’ll want to ensure that your insurance company has a copy of your file and the decision awarding your benefits. Likewise, if you see a new specialist to treat your medical conditions, you will want to get copies of those records submitted to the insurance company, as well.

Most ERISA-governed long-term disability benefits plans require that claimants appeal the denial of benefits through an administrative process with the insurance company prior to filing a lawsuit to challenge the denial. Sometimes there is one appeals process that you must go through before going to court, but there may be two levels of appeal under some insurance plans. However, you still can continue to submit new evidence to the insurance company during the appeals process, up until you receive a final notice of denial of benefits from the insurance company.

It is particularly important that you submit any new or additional evidence that you have in support of your claim to the insurance company while either your initial claim or a subsequent administrative appeal is pending. This is because once you receive a final denial of benefits from your insurance company, you no longer can submit any new or additional information in support of your claim. Therefore, if you choose to challenge the denial of benefits through a federal court lawsuit, you will NOT be permitted to provide any more information to the judge other than what the insurance company already has in its possession. The judge will only consider the evidence in your case that you already have submitted to the insurance company.

Building your administrative file to contain all important and persuasive medical evidence can make an important difference on your claim if a lawsuit is ever required. Therefore, many claimants may choose to take the entire appeal timeline before finally submitting a full appeal in order to make sure that all treatment notes, medical records and other evidence are submitted to the insurance company.

Bonnici Law Group has the experience and knowledge that you need as you fight back against a denial of your long-term disability benefits. We know how to help you build a strong claim for benefits supported by medical evidence and obtain the best outcome possible in your case. Do not hesitate to contact Bonnici Law Group at 858-261-5454 or help@bonnicilawgroup.com.