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.