What’s The ERISA Disability Timeline?
ERISA long-term disability (LTD) is a topic of much controversy because it usually arises in relation to disability claims and the difficulty involved in getting claims approved. Few people realize how easy or common it is to become disabled and even fewer people expect that a sudden disability will last for a long period of time or significantly affect their lives.
However, serious disability is something that people should really consider and plan for and everyone with disability insurance needs to be well aware of the stipulations and qualifications of his or her particular policy.
All health and disability benefit claims must be decided within a specific time limit, depending on the type of policy and/or claim filed. Disability claims are requests for benefits where the plan must make a determination of disability to decide the claim.
Submitting the Claim
Disability claims must be decided within 45 days after the plan has received the claim. If more time is needed to review the request, the plan can extend the timeframe up to 30 days. The plan must tell you prior to the end of the first 45-day period that additional time is needed, and when the plan expects to render a final decision. If more information is requested during either extension period, you will have at least 45 days to supply it.
The claim then must be decided no later than 30 days after you supply the additional information or the period of time given by the plan to do so ends, whichever comes first. The plan must give you notice whether your claim has been denied before the end of the time allotted for the decision.
Claim is Denied
If your claim is denied, the plan administrator must send you a notice, either in writing or electronically, with a detailed explanation of why your claim was denied and a description of the appeal process. In addition, the plan must include the plan rules, guidelines, or exclusions (such as medical necessity or experimental treatment exclusions) used in the decision or provide you with instructions on how you can request a copy from the plan. The notice may also include a specific request for you to provide the plan with additional information in case you wish to appeal your denial.
If the plan’s final decision denies your claim, you may want to seek legal advice regarding your rights to bring an action in court to challenge the denial. Normally, you must complete your plan’s claim process before filing an action in court to challenge the denial of a claim for benefits. However, if you believe your plan failed to establish or follow a claims procedure consistent with the Department’s rules, you may want to seek legal advice regarding your right to ask a court to review your benefit claim without waiting for a decision from the plan. Click here for a free evaluation of your disability claim.
The author, Joshua Bonnici, is the managing attorney at BONNICI LAW GROUP, APC, who represents injured and disabled individuals fight for fair and just outcomes. Feel free to learn more and reach out for a free case evaluation HERE, firstname.lastname@example.org, or at: 619-259-5199.