If you or someone you know is unable to work due to illness or injury you have likely filed, or are about to file, a disability insurance claim. Not being able to earn an income can be scary. It is important to know that your employer’s disability insurance company has certain obligations when reviewing your long term disability claim. In addition to certain procedures that must be followed, the federal law that governs your disability claim also places a certain time frame on when a decision must be made by the insurance company.
Understanding ERISA
It may seem that the Employee Retirement Income Security Act of 1974 (ERISA) has nothing to do with your long term disability claim at first blush. Right now you are disabled and unable to return to work, you are not trying to retire. However, ERISA governs most employer-sponsored welfare benefits - including disability benefits. If your long term disability claim is governed by ERISA you must be notified of your coverage and benefits, informed about how to file a disability claim, and the insurance company must make a decision within a certain time frame.
Waiting on a Decision
ERISA places the following time limits on insurance companies when they are deciding whether or not to pay a long term disability claim.
If you filed an initial claim, the insurance company typically has to make a decision quickly. Generally, a disability insurance company has 45 days to make a decision once all of the necessary documentation is received from you and your employer. The insurance company may request two 30 day extension if they need more time to make a decision. These requests for extensions must be provided to you in writing. Therefore, the maximum time an insurance company may take to make a decision on your long term disability claim is 105 days.
If your claim was denied and appealed the decision, the insurance company’s typical timeframe to make a decision is even shorter. Generally, a disability insurance company has 45 days to make a decision once the appeal is received. The insurance company may request one 45 day extension if “special circumstances” require the additional time. If an extension is requested, you must be notified in writing. Therefore, the maximum time an insurance company may take to make a decision on your long term disability appeal is 90 days.
What to Do While You Wait
Waiting on a decision can be hard. This is particularly true when you are facing medical issues and also not receiving any income. An experienced long term disability attorney will push hard to make sure the insurance company makes a timely decision.
If you are waiting on a decision on your long term disability claim or appeal, there are steps you can take during the process. First, be sure to continue receiving medical care. Since you bear the burden of establishing continued disability, you will need this evidence throughout your case. Second, tell your doctors about your symptoms and your limitations. Documentation in the medical record is key in long term disability cases so make sure your physicians are recording your difficulties in their notes. Keep in mind that generally, the only evidence considered by a court in a ERISA disability case is what is provided to the insurance company up to the date of the final denial. For this reason, it is critical to hire a knowledgeable long term disability attorney to handle your case.
How We Can Help
Our law firm has always focused only on disability insurance law. We have successfully represented hundreds of clients across the country. We have won several major disability lawsuits and have fought UNUM, Hartford, MetLife, CIGNA, Prudential, and more. Because federal law applies to most disability insurance claims, we can help you even if we are not located in your state.
Disability insurance companies have lawyers. You should too. Call Dabdoub Law Firm to get experienced disability lawyers on your side.
We can help with:
- submitting a disability insurance claim;
- appealing a long-term disability denial;
- negotiating a lump-sum settlement; or
- filing a lawsuit against your disability insurance company.
Call for a free consultation with one of our disability attorneys today.
Because each client’s case is unique and has different facts, results similar to those in other clients’ cases are not guaranteed.