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What time frames apply to an ERISA disability appeal?


  • Time to File an ERISA Disability Appeal?

Many people want to know how long it’s going to take in filing an appeal on a claim that’s governed by ERISA.

Once you’ve received the denial letter, usually read through it, the shock and the first thought that comes to mind is, I can’t believe they did this. Well, they provide you 180 days to answer, to follow your appeal. And 180 days seems like a lot of time, 6 months without pay can hurt anyone.

However, the appeal becomes probably, the most important piece of your claim now. Because under ERISA you are not going to receive a jury trial, you’re going to go to trial in front of a federal judge and he is going to look at the administrative record which is going to be what the insurance company has in their claim file and which you submitted as additional evidence in your appeal. Therefore those 180 days become the most important. Because these benefits may last until your 65th birthday. Thousands and thousands of dollars can be at stake.

We generally will take as much time as possible to make sure as much medical evidence is contained within that appeal to overturn whatever the decision might be. Once the claim is submitted, the insurance company under Federal statute has 45 days to respond to your appeal. However, up until the 45th day, they are allowed to ask and request for one additional 45 day extension for a total of 90 days. So quite often what should have been a 6 month process may become a 9 month process. Then, if they do overturn their denial, it maybe a month and more before you start seeing benefits again. So it could take upwards close to a year before you start seeing money if they do overturn their decision on your appeal.

There are 2 opinions so far. Add your comment below.

John O.:

I was laid off after 3 absent periods that exceeded 6 months for being hospitalized for health issues, so after a while I was switched to long term disability. Now it’s 5 years later after being laid off, my previous employer is sending letters that I must start drawing dollars from a retirement fund if I had reached the age of 55, plus they were saying that my pension hasn’t been collecting interest anymore and it would be in your best interest if you flipped over all funds, Your pension benefits are being held by AOX.
So we started received $62.60 per month after taxes, so I included the amount as my income, at the same time I applied to DRS benefits to rollover my pension in the amount of $100k, and send me a check for $47k which after taxes amounted to $36k
we used the $36k to pay back the credit cards and second mortgage that we had to get to keep the home running and to keep vehicles for transportation.
Again we listed that money $36k on our prudential report,
A few weeks go by and we get a call from our claims manager Paula Marino of Prudential LTD about retirement the $62.60 we are receiving and the $36k we used for paying off bills and 2nd mortgage she said that the $62.60 is going to be an offset and the others no problem! So after reading the Prudential LTD Group Policy #1404 pages 28 & 29, The $62.60 amount falls under the listing in the policy #1404 of non-qualifying plans of Deferred compensation. A few days go by and now she’s asking about the $36k, she told us before not to worry about that, but here it goes, Prudential is now telling me to come up with a check for $3649.00 by 28 July 2016 and they are off setting $366.01 of our monthly benefits!

I can’t believe this she has told me on a recorded phone call to Prudential that I don’t need to worry about the $36k! Now Paula Marino says that Prudential wants the Gross amount $47K paid back to them? Now all of these transactions were completed in 2015 which we have paid taxes on and fines, we had to kick in $2275 on our 2015 taxes and now 2016 we are prepaying quarterly $570.00 every 3 months. Where does all of this mean to my 2015 & 2016? So we are bearing the burden of over paying taxes.
Do we have a case? How about Federal taxes?

Thank you,
John OBrien
(321)632-2976

Attorney Stephen Jessup:

John, please feel free to contact our office to discuss your case. With respect to tax questions you will need to consult with a qualified tax specialist.

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