If your short-term disability (“STD”) or long-term disability (“LTD”) claim has been denied, you have 180 days under ERISA to submit an appeal to the insurance carrier.
Once an appeal is submitted to the carrier, the insurance company has 45 days to review and make a decision, unless there are special circumstances that warrant an extension.
What happens if you submit an appeal and the insurance company ignores you for those 45 days?
You have the right to take legal action.
The United States District Court for the Southern District of Florida clarified this situation in Roldan v. Principal Life Insurance Company.
At nine months pregnant, Ms. Roldan was struck by a moving vehicle and experiencing ongoing symptoms as a result, including headaches, visual disturbances, chronic pain, hearing loss and memory loss. Due to these conditions, Ms. Roldan became disabled and submitted a claim for long term disability insurance benefits to Principal Life insurance Company (“Principal”).
Principal approved and paid long term disability insurance benefits for a number of months but later terminated benefits claiming Ms. Roldan was no longer disabled.
Our office timely submitted an appeal to Principal enclosing additional evidence in support of her disability.
After 45 days and three follow-up letters, Principal failed to provide a final appeal decision. Thus, our office filed a lawsuit in the Southern District of Florida against Principal for violating ERISA regulations.
Principal filed a “Motion to Remand and Stay the Proceedings” requesting the Court to remand the action back to Principal so it may continue reviewing the appeal without Court interference.
Our office filed a response to Principal’s Motion notifying the Court that the Department of Labor amended its ERISA regulations to lay out specific consequences for an administrator’s (i.e. Principal) failure to follow claims procedures, specifically failure to make a timely appeal decision.
The regulation is clear: failure to respond to a claim (or appeal) within 45 days is deemed a denial and allows a claimant to seek judicial review.
The Court denied Principal’s Motion to Remand concluding that Principal plainly violated ERISA procedures and made no attempt to seek an extension. The Court also noted that remanding the case back to Principal would cause even further delay.
This case demonstrates the importance of having an expert in disability insurance law on your side. Most people do not know that they can take legal action when their disability insurance carrier delays a claim decision.
Lawyers with Expertise in Disability Insurance Claims
This law firm has always focused only on disability insurance law.
Because we specialize in long term disability, our clients get the benefit of:
- Having an attorney who is an expert in long term disability claims;
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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.
The firm represents clients nationwide with disability claims governed by federal law, even if we are not located in your state.
Call (800) 969-0488 or contact us online to speak with an experienced disability attorney. Pay no fees or costs unless you get paid.
