If your long-term disability claim is denied, do not despair. The fact is that the majority of disability claims are denied initially and there is an appeals process. Disability claim appeals are subject to a statute of limitations. If the appeal is not filed within that timeframe, it generally cannot go forward.
When you receive a denial letter from your insurance company, the document typically includes information about how long you have to file an appeal. A seasoned long-term disability attorney at Marc Whitehead & Associates will ensure that the statute of limitations for filing an appeal is met.
The Significance of the Statute of Limitations for Disability Appeals
There is no underestimating the significance of the statute of limitations for disability appeals when it comes to employer benefits plans. You typically only have a limited window of time in which to submit new evidence rebutting the denial.
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Defining the Statute of Limitations
The federal Employee Retirement Income Security Act of 1974 (ERISA) mandates deadlines for appeals, also known as statutes of limitations. However, different policies have different deadlines.
You should receive a Summary Plan Description of your long-term disability policy from your employer. The SPD states the statute of limitations for your plan.
Deadlines also vary by state. While there is no national ERISA deadline, states – and insurance companies – impose time limits. An attorney will let you know the deadline for your state. The insurance company’s deadline may be shorter than the state statute of limitations.
Understanding the Timeline
Initial Claim Denial Notice
The initial claim denial notice contains specific information on why your claim was denied and its review procedures. It will state the plan provision denying benefits.
If your claim was denied for medical reasons, the denial notice states how that medical information was used to reach the decision.
Commencement of Statute of Limitations
The statute of limitations for filing an appeal generally starts as of the date of the denial letter. Your denial letter will have information regarding the ERISA disability statute of limitations.
In some instances, the denial letter may include the exact date on which the statute of limitations ends, but that depends on your insurance company and policy.
Duration of the Statute of Limitations Period
Under ERISA, you have 180 days from the date of the initial claim denial notice to file your denial letter appeal. A decision by the insurance company or plan administrator regarding the appeal must be completed within 45 days.
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What Happens if I Miss the Appeal Deadline?
If you miss the appeal deadline, your claim will probably be dismissed. You cannot recover benefits. Again, it is essential that your appeal is filed within the statute of limitations.
Under ERISA, you cannot file a long-term disability lawsuit until you exhaust all administrative remedies, which includes the appeal. If you file such a lawsuit without having exhausted administrative remedies, the defendant will almost certainly file a motion to dismiss the lawsuit and a judge is likely to grant the motion.
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Legal Assistance and Representation
Perhaps you did not see the need for legal representation when filing your long-term disability claim. After receiving a denial letter, you can understand the necessity of legal assistance when it comes to a matter of such critical importance to your future well-being.
Benefits of Hiring an Attorney
Appealing a disability claim denial is complicated. This is not an issue you should attempt to resolve on your own. It is also essential that the appeal is filed in a timely manner. Contacting a long-term disability lawyer as soon as you receive your denial letter is crucial.
Keep in mind that insurance companies and employers have skilled lawyers representing them. If you do not have the benefit of legal counsel, you are at a serious disadvantage. You need someone to protect your rights and represent your interests.
Finding the Right Legal Professional
ERISA is an extremely complex area of law. You need an attorney specializing in ERISA long-term disability claims and appeals. Hiring the right legal professional can make the difference between your eventually receiving benefits or having your appeal denied.
When seeking legal help, ask the attorney about their track record on winning ERISA long-term disability appeals.
Attorney’s Role in the Appeal Process
Your attorney plays a critical role in the appeal process. They will review the insurance company’s claim file and its denial letter carefully. They will help you compile all of the medical and occupational evidence necessary to file the appeal.
If your appeal is denied, you still have the right to file a lawsuit. However, you cannot introduce any new evidence in litigation. Your attorney will work with your treating physician to ensure your appeal’s medical documentation is thorough and complete.
Contact a Long-Term Disability Attorney
A long-term disability lawyer at Marc Whitehead & Associates will guide you through the appeal process every step of the way. Contact us today to schedule a free, no-obligation consultation. We fight for you to receive the long-term disability benefits you deserve.
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