If you have applied for long term disability benefits, you may experience a denial. It is very common for claimants to be forced to appeal a decision after submitting their claim for the first time. When you receive notice from the insurance company that your claim has been denied, the clock starts ticking down for you to file an appeal.
How Do Deadlines Affect You?
With most long term disability claims, the appeals process is mandatory. You must exhaust your appeals before you are allowed to take your case to Federal Court to determine your eligibility for benefits. This means that filing your appeal has to be completed within in the time-frame set forth in your long term disability insurance policy. If you miss a deadline, you could forfeit your right to appeal the decision in the future and will not be able to bring a lawsuit in court. There have been many challenges to strict deadlines over the years, but courts generally rule in favor of the insurance companies in most cases.
Under ERISA, you normally have 180 days from the time you receive notice to file an appeal. However, every long term disability plan is different, and the deadline varies. Get a copy of your LTD policy from your employer as soon as you know you plan to file and read it thoroughly to understand your rights and your responsibilities during the claim period. Some policies require that you file your initial claim within 30 days of your injury or disability diagnosis. Some insurance companies require you to exhaust all your short term disability benefits before applying for long term benefits.
Keep in mind that even if you are on day 182 or so, and your policy requires an appeal within 180 days, you may have some “wiggle room” if your denial letter says something like “you must file an appeal within 180 days of the date you receive this letter”. As it can take approximately 5 days for mail to arrive from the date on the letter, you may have something like 185 days to file an appeal.
Fortier v. Hartford Life & Accident Ins. Co., __F.3d__, 2019 WL 697989 (1st Cir. Feb. 20, 2019)
In this case, Mrs. Fortier was receiving disability benefits from her long term disability company. She received a letter in September that her benefits were going to be terminated in November (two months later). She believed that her 180-day time clock started in November when her benefits were terminated, but actually, her 180-day time clock started in September when she received the notice. She did not send in her appeal letter until two months after her 180-day window had closed. Ultimately, the First Court of Appeals ruled against her citing that the law states the deadline starts from the date claimants receive notice.
Good Excuses for Missing Deadlines
So what is a good excuse for missing a deadline? Ultimately, nothing. If you miss your appeal deadlines, it is very likely you will not be able to continue pursuing your claim further. You will also not be allowed to add additional documents to your claim to help strengthen your case. Obtaining and submitting all your supporting documents on time is critical to a successful claim.
Request the Claim File
One of the first things you should do after you receive a disability denial letter from the insurance company is to request a copy of your claim file in writing from your LTD insurance company. By federal law, the insurance company is required to provide you with a free copy of your entire claim file if your claim has been denied or terminated.
What is the Definition of Disability in Your Policy
Your insurer’s definition of “disability” in your long term disability policy can make a big difference in your case. Some policies define disability as the inability to perform any occupation. In contrast, others state you are disabled under the policy if you cannot perform the material duties of your own occupation. You can usually determine how the insurance policy defines disability in your policy’s summary plan description, the insurance company’s denial letter, or in the insurance policy itself.
Working With a Long Term Disability Attorney
Since you are so limited by the appeals process, consider consulting a disability attorney very early on. It can be tricky to navigate the claims and appeals process, but working with an experienced disability attorney will give you the best chance of getting the benefits you deserve. If you have been denied disability benefits, do not lose hope. Many people are denied benefits the first time they apply. You have the right to file an appeal and to get more information that may help your case.
While the process can be daunting, your expert disability attorney will be able to guide you through the process. Getting expert help is often the difference between being denied and being approved for benefits. An experienced long term disability attorney can help you stay on top of your deadlines, help you gather your documents, assist you during field interviews, and give you guidance that will help you get your claim approved. They do not get paid until you win your case. You can seek help without worrying about upfront costs or unexpected bills.
The Ortiz Law Firm has successfully represented people in disability cases across the United States. If you would like to talk to an experienced disability lawyer about your case, the Ortiz Law Firm offers a free consultation with no obligation to use our firm. During the call, you can ask any questions you have regarding your claim, and we will answer them. To see how we can help you win your long-term disability case, call us at (888) 321- 8131.