When an insurance company “tolls” its decision in a claim, it means that they are extending the time limit for making a decision on the claim. Essentially, the insurer is delaying its decision and is not yet ready to provide an answer or a resolution to the claim.
The reason why an insurance company might toll a decision could be due to a variety of factors such as further investigation of the claim, waiting for additional information, or consulting with legal or medical experts.
In the United States, the Employee Retirement Income Security Act (ERISA) sets a standard for the claims process and requires insurers to make a decision on a disability claim within 45 days of receiving a an appeal of a denial of benefits, with the possibility of a 45-day extension under certain circumstances.
But what if the insurance company requested additional information in evaluating the claim, such as the report from a Social Security disability consultative medical examination? Or perhaps the insurance company is waiting on the report from one of its reviewing physicians? Even if the 45-day extension is invoked, the insurer may assert that the clock is “tolled” or paused, and the time limit is extended until the additional information is received.
In our opinion, these are obvious delay tactics by the insurance company, and it is questionable whether tolling is even permitted under ERISA.
It is important for policyholders to be aware of the tolling process as it can affect the time frame for receiving compensation for their claim. If you are unsure about the status of your claim, it’s always best to reach out to your insurer and inquire about the progress of your claim.