• Disability Insurance Denial and ERISA Appeal Deadlines Prior to LawsuitDisability Insurance Denial and ERISA Appeal Deadlines Prior to Lawsuit

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

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.

Leave a comment or ask us a question

There are 10 comments

  • 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.

    Cesar GavidiaAug 15, 2018  #10

  • 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?

    MarieAug 14, 2018  #9

  • 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.

    Rachel AltersJun 8, 2018  #8

  • 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?

    N. GinaJun 7, 2018  #7

  • 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.

    Rachel AltersApr 17, 2018  #6

  • 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?

    J. PatrickApr 16, 2018  #5

  • 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.

    Stephen JessupMay 6, 2014  #4

  • 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.

    Island LadyMay 5, 2014  #3

  • 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.

    Stephen JessupOct 10, 2013  #2

  • 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.

    ReneeOct 9, 2013  #1

FAQ

Do you work in my state?

Yes. We are a national disability insurance law firm that is available to represent you regardless of where you live in the United States. We have partner lawyers in every state and we have filed lawsuits in most federal courts nationwide. Our disability lawyers represent disability claimants at all stages of a claim for disability insurance benefits. There is nothing that our lawyers have not seen in the disability insurance world.

What are your fees?

Since we represent disability insurance claimants at different stages of a disability insurance claim we offer a variety of different fee options. We understand that claimants living on disability insurance benefits have a limited source of income; therefore we always try to work with the claimant to make our attorney fees as affordable as possible.

The three available fee options are a contingency fee agreement (no attorney fee or cost unless we make a recovery), hourly fee or fixed flat rate.

In every case we provide each client with a written fee agreement detailing the terms and conditions. We always offer a free initial phone consultation and we appreciate the opportunity to work with you in obtaining payment of your disability insurance benefits.

Do I have to come to your office to work with your law firm?

No. For purposes of efficiency and to reduce expenses for our clients we have found that 99% of our clients prefer to communicate via telephone, e-mail, fax, GoToMeeting.com sessions, or Skype. If you prefer an initial in-person meeting please let us know. A disability company will never require you to come to their office and similarly we are set up so that we handle your entire claim without the need for you to come to our office.

How can I contact you?

When you call us during normal business hours you will immediately speak with a disability attorney. We can be reached at 800-682-8331 or by email. Lawyer and staff must return all client calls same day. Client emails are usually replied to within the same business day and seem to be the preferred and most efficient method of communication for most clients.

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Jeffrey G.

Excellent legal services From Dell & Schaefer.

I had the opportunity to use the law firm of Dell & Schaefer of Hollywood, Florida. Greg Dell met with me during the initial consultation and explained my policy benefits. My situation was rather unique due to the fact it was a Mental/ Nervous condition which are often the most challenging to get approved. The firm spent a significant amount of time on my case and at a very reasonable fee. Through their hard work and legal expertise my claim was approved in a timely fashion. I would highly Greg Dell to anyone in need of a disability attorney.

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