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Why Must AN ERISA Disability Appeal Be Filed Within 180 Days?


  • Disability Insurance Denial and ERISA Appeal Deadlines Prior to Lawsuit

Attorney Rachel AltersAuthor: Attorney Rachel Alters

On a daily basis, the law firm of Dell & Schaefer receives countless calls from claimants who have failed to file their administrative appeals within the required 180 day. Unfortunately, under ERISA regulations, once the 180 day time limit has expired the insurance company is not required to accept your appeal. If your insurance company refuses to accept the untimely appeal, your claim will be closed and a court will likely dismiss a lawsuit against them to recover the money you are rightfully owed. This can be very frustrating and disheartening to claimants who are relying on this income to support their families.

WHAT IS AN ADMINISTRATIVE ERISA APPEAL AND HOW WILL I KNOW WHEN MY ERISA APPEAL IS DUE?

If you have a group disability policy chances are it’s governed by federal law under an act called the Employment Retirement Income Security Act of 1974 (ERISA). Your rights under ERISA are more restricted than those under state law. When your benefits have been denied or terminated it is critical to be aware of the strict deadlines that must be adhered to. Insurance companies are banking on claimants’ lack of understanding of these rules in hopes that the deadlines will be blown and the insured will have no recourse. If your benefits are denied, ERISA requires that you file an administrative appeal directly to the insurance company. This is your only opportunity to present your case as once the administrative record is closed (after the expiration of 180 days) nothing else may be added no matter how critical the information may be. If you end up in a court of law, the only information the judge will consider is information that was provided during the appeals process and nothing else.

When you receive a letter from your insurance company, it will contain language similar to the following:

You may appeal this decision by sending a written request for appeal to Hartford within 180 days after receipt of this denial letter. In the event the appeal is denied in whole or part, you will have the right to bring a civil action under Section 502(a) of the Employee Retirement Income Security Act of 1974.

To help ensure you prevail and receive the benefits rightfully owed to you, it is pertinent to be aware of and calendar the deadline to submit your appeal and contact a disability insurance attorney specializing in ERISA to assist in preparing your appeal. Contact us for a free consultation and we will let you know immediately if we can assist you.

There are 10 opinions so far. Add your comment below.

Renee:

If your benefits get denied and you go through the process of appeal and win. Your benefits will be reinstated but what is stopping the insurance company from denying your benefits again 6 months or a year later. How often can an insurance company do this to you? I would think going to court is no big deal for a big insurance company but a it is a very big deal for an individual that doesn’t have much income.

Attorney Stephen Jessup:

Renee,

You are correct- there is nothing to stop them from investigating or denying your claim 6 months, a year, or whenever down the road. Unfortunately it is perfectly legal, as review for entitlement to disability benefits is a month to month analysis. Disability benefits are unfortunately never guaranteed.

Island Lady:

So my question is… If you didn’t know you needed to appeal Aetna, when they stopped sending my LTD checks, with in 180 days? And it’s been years? You’re just out of luck? I was told I was paid to the contract max amount? I worked at Boeing. I also had a UNUM Policy through the Machinist Union, I never received payment for anything. I sent faxes and sent them Dr. statements and constant phone calls . Where I was passed from person to person, I’m sure it was all a big joke to them. However to me it was money I needed. It was a policy I paid for thinking if I ever needed it would be there? I was constantly turned down by Unum for one reason or another. Hard to appeal something you never received any payment on? Social Security Disability has paid me now for 13 years. Is there a statute of limitations for collecting payment from a disability claim? And, how does a person even know if they don’t get a attorney? They will be at the mercy of these Bad Faith Companies that just care about their bottom line.

Attorney Stephen Jessup:

Island Lady,

Yes, there are applicable statute of limitations to file a lawsuit for denial of benefits, and strict guidelines about filing required administrative appeals. Unfortunately, if 13 years have passed since their denials, then there would be unable to assist you.

J. Patrick:

Does the ERISA statute require that the appeal period be 180 days after the “receipt” of the denial letter, or can the LTD insurer require the appeal be filed within 180 days of the date of the denial letter, and then wait a month before mailing it?

Attorney Rachel Alters:

J. Patrick, ERISA allows for the appeal to be received 180 days from the date the letter is received by you. Hopefully you kept the envelope which should show the date they mailed it.

N. Gina:

I realized I had 180 days from the “receipt” of the denial letter, but the letter was dated 12/7, but post marked 12/8, but I received it 12/13. Will I get at least five extra days for mailing? 12/7 plus 5 days + 180 days?

Attorney Rachel Alters:

Gina, according to ERISA rules and regulations you have 180 days from the date you received the letter on 12/13 to submit your appeal. I suggest you fax and mail it to ensure it gets there on time.

Marie:

Can I ask for an extension past the 180 days due to the slow process of them getting files to me that I could open?

Attorney Cesar Gavidia:

Marie, you may request an extension past 180 days to file your appeal; however, it is the within the disability insurer’s discretion to grant you that extension. Most disability insurers adhere strictly to the ERISA deadlines and require you to submit your entire appeal by the 180th day. Others allow you an extension of time if you request the extension prior to the 180 day appeal deadline expiring. Please contact our office to discuss the matter with a disability insurance attorney.

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