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Deadlines To Be Aware of When Filing an ERISA Claim

If your long-term disability insurance coverage is a benefit you receive from your employer, it likely falls under the jurisdiction of the Employee Retirement Income Security Act of 1974 (ERISA). This highly complex body of federal legislation makes life very difficult for disability insurance claimants in a host of ways, including through its imposition of mandatory claim-ending deadlines.

So, what are the most important ERISA disability deadlines to be aware of?

The Summary Plan Description (SPD)

ERISA requires employers providing long-term disability insurance to give their covered workers copies of the summary plan description (SPD). This document outlines, in simple language, all the important details of the insurance plan, including the deadlines you must adhere to when filing a claim or appeal. If you receive employer-sponsored long-term disability insurance that falls under the jurisdiction of ERISA, the legislation requires that you receive your SPD within 90 days of the onset of your coverage.

Different ERISA policies have different deadlines. Consulting the SPD for your policy is the best way to ensure you know exactly which time limits you must obey.

Deadlines When Filing an Initial ERISA Disability Insurance Claim

The first task you’ll face after your physician informs you of your disabling condition and your inability to work is the submission of your notice of claim to your insurance company. This is relatively simple, but the allowed time here is usually just 20-30 days, so you can’t afford delays.

Once you inform the insurance company of your situation, the insurer will send you additional documents to complete in order to progress your claim. After this, the next deadline you’ll have to meet will be for your Proof of Claim, which will contain a number of documents related to your employment and finances as well as your disability. The Proof of Claim is a tricky legal calculation, often missed by unsuspecting claimants.

Appealing an Adverse Benefit Determination

An adverse benefit determination occurs when your insurance company denies your claim for monthly disability benefits or makes any decision to terminate or reduce your benefits. ERISA generally requires that claimants get 180 days (approximately six months) within which to file an appeal following such a determination.

This may seem like plenty of time, but the mandatory appeals process on ERISA disability claims can be very time-consuming, particularly without the assistance of a seasoned disability insurance lawyer. It requires you to complete what is called a comprehensive administrative appeal; this is a compilation of all the medical, occupational, and financial evidence related to your claim. You must also submit any ERISA case law that is relevant in your federal jurisdiction at this stage.

Crucially, you cannot introduce any new evidence once you have submitted your administrative appeal because the record is closed. So, if your insurer denies your claim again at the appeal stage and you wish to bring the company to court, you may rely only upon the evidence you have already submitted for consideration.

Contractual Limitation Periods Related to Filing ERISA Disability Lawsuits

ERISA does not contain its own statute of limitations. This means there is no provision within the legislation that sets a strict time limit on claimants who wish to file a lawsuit after a claim denial. However, the states have imposed their own statutes of limitations on ERISA disability claims, which means the deadline varies depending on where you live. Additionally, individual insurance contracts have their own enforceable time limits which may be shorter than the statutory limit in your state. Failure to file suit in time may result in the invalidation of your claim and the loss of any potential monthly disability insurance benefits.

Many policies require you to bring your case within three years of the date on which “proof of loss” first becomes due. Proof of loss is a requirement set out by ERISA disability insurance companies; it can consist of different things in different cases, but will generally include records of medical tests or treatments, or any other item that can prove the nature and extent of your disabling condition. In 2013, in the case of Heimeshoff v. Hartford Life & Accident Insurance Co., the US Supreme Court confirmed that this three-year deadline in ERISA disability insurance contracts was legally enforceable.

What Is an Elimination Period?

If your claim succeeds, you won’t be entitled to start receiving monthly disability insurance benefits right away. Instead, you’ll have to wait for your elimination period (also known as a waiting period) to elapse. The lengths of these periods vary from one policy to the next; ERISA long-term disability policies generally impose waiting periods of between 90-180 days. The clock starts running on the day your physician officially states you have a disabling condition and that you’re unable to work in your full- or part-time occupation.

Getting the Timing Right on Your ERISA Long-Term Disability Insurance Claim

When you’re filing for long-term disability insurance benefits on an employer-sponsored policy, there’s a lot more to the process than simply having a valid claim. If you don’t follow the proper procedures, such as submitting documentation by the relevant deadlines, you may fail to secure the monthly benefits to which you should be entitled.

Getting a top-class Chicago ERISA attorney on your team is the easiest and most effective way to minimize this risk. Contact DarrasLaw today to schedule a free initial consultation with one of our lawyers, including a free policy analysis, claim assistance, or appeal assistance.

DarrasLaw is Americas' most honored and decorated disability litigation firm in the country. Mr. Darras has seen more, evaluated more, litigated more, and resolved more individual and group long term disability and long-term care cases than any other lawyer in the United States.

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