If your disability benefits were provided by your private employer, then your policy is governed by the federal law known as ERISA – which stands for the Employee Retirement Income Security Act of 1974. Under ERISA, an insurance company has an initial 45 days to make a decision on your claim but can take up to two 30-day extensions if they need more time. In total, the insurance company can take up to 105 days to tell you if your claim is approved or denied.
It is important to understand that the clock doesn’t start ticking until the date the insurance company has all of the information (or proof of claim) it needs from you and your employer. While every policy is different, this information usually includes proof of:
- The regular care and treatment you’re receiving from a doctor;
- Your monthly earnings;
- The date your disability began;
- The severity of your disabling health condition(s); and
- Your restrictions and limitations preventing you from working.
If the insurance company denies your claim, you have the right to appeal their determination. Now, they have even less time to make a new decision under ERISA. The insurance company has an initial 45 days to approve or deny your claim on appeal. If they need an extension of up to 45 days, they must put it in writing and show that “special circumstances” exist to justify the need for more time. So, in total, insurance companies have up to 90 days to approve or deny your claim on appeal.
Submitting a claim or appeal, and then waiting for a decision, can be complicated and overwhelming. That is why we strongly recommend speaking with an experienced long-term disability attorney who can help you with:
- Submitting your disability insurance claim;
- Making sure the insurance company meets their deadlines;
- Appealing a denial or termination of your long-term disability benefits;
- Managing your ongoing claim;
- Negotiating a lump-sum settlement; or
- Filing a lawsuit against your disability insurance company if they deny your appeal.
Call for a free consultation with a disability attorney. No fees or costs until you get paid.
