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.