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.
If you didn’t meet your appeal deadline, you should not presume that your case is over. It is recommended that you promptly consult an expert such as those at Ortiz Law Firm to clarify if the standard 180-day deadline applies to your situation.
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 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 of the denial or termination of your claim to file an appeal. However, every long-term disability plan is different, and the deadline varies. Request a copy of your LTD policy from your employer or your insurance company as soon as possible 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 any short-term disability coverage before you apply for long-term disability 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.
Example: Fortier v. Hartford Life & Accident Insurance Company
In this case, Mrs. Fortier was receiving disability benefits from Hartford, 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 allowed to pursue 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.
Working With a Long Term Disability Attorney
The appeals process is critical to the success of your claim. Navigating this process can be difficult, but having a skilled disability lawyer on your side can help you secure the benefits you deserve. Professional assistance can often spell the difference between the success or failure of your appeal.
A proficient long-term disability lawyer will ensure you meet crucial deadlines, collect necessary documentation, support you during interviews, and offer invaluable advice to enhance the likelihood of your claim’s acceptance. You only have to pay a fee once you win your claim, so there are no upfront fees to get started.
The Ortiz Law Firm has a strong track record of successfully representing clients across the nation in their disability claims. If you would like to speak with an attorney, the Ortiz Law Firm offers a free case evaluation. We are here to address any questions you may have about your claim. To learn more about how we can help with your appeal, please call us at (888) 321- 8131.