By the time you receive your short-term disability or long-term disability denial letter, the clock has already started ticking for the appeal process. If your disability insurance claim is governed by ERISA, the appeal process has a strict time frame. You do not want to waste any time with your appeal because it is your last chance to get supporting evidence into your claim file.
Appeal must be submitted within 180 of the denial letter
From the date of the letter, you typically have 180 days to submit your appeal to the insurance company. During that time you want to gather as much evidence as you can to prepare your appeal. This could include:
- medical records,
- Letters and/or questionnaires from your doctors,
- outside testing,
- independent reviews,
- functional capacity evaluation report
The insurance company's deadline to make a decision
Once your appeal is submitted, the insurance company is on a deadline to make a determination. They have 45 days to make a determination. Under ERISA, the insurer can take one 45-day extension for special circumstances. For example, though, a special circumstance does not include conducting medical reviews. Disability insurance companies routinely conduct medical reviews during the appeal process. There is nothing special about those reviews.
During the appeal review, if the insurer obtains a medical review or any type of evidence that is not favorable to you, you should be given a chance to respond to it. Sometimes, you may need extra time to provide your response. You may need to get a letter from your doctor or some other evidence to rebut the insurance company’s review.
The extra time it takes for you to do this may “toll,” or pause, your review. However, it does not add time to the insurance company's timeline to make a decision.
If the timeline is followed properly, the insurance company should make a decision within 45 days after you submit your appeal but cannot take more than 90 days.
The ERISA appeal deadlines are very important. Missed deadlines can alter the outcome of your case should it end up in litigation. Having an experienced ERISA disability insurance attorney on your side protects your claim.
Help from a Lawyer with Expertise in Disability Insurance
Disability insurance law is complex. Hiring an experienced disability attorney is important. Because all disability lawyers at this law firm focus on disability insurance claims, we have expertise in disability insurance law.
That means have:
- Experience with every major disability insurance company;
- A proven track record of success by winning major disability lawsuits;
- Recovered millions of dollars in disability benefits for clients;
- And, we never charge fees or costs unless our clients get paid.
The firm can help at any stage of your disability insurance claim, including:
- 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.
Because federal law applies to most disability insurance claims, our lawyers are able to represent clients across the country.
Call Dabdoub Law Firm today at (800) 969-0488 to speak with an experienced disability attorney. Consultations are free.
