Insurance companies are widely known for taking their sweet time about paying benefits for any reason. How badly you and your family need those benefits isn’t their concern, and they’ll typically do whatever they can to deny or delay payments.
But if your long-term injury or illness is covered under an employer’s long-term disability (LTD) plan, ERISA protections are in place, limiting insurer decisions to a reasonable timeframe. That’s crucial if your condition keeps you from working and earning an income.
When to expect a decision
For ERISA-backed LTD plans, insurers must decide within 45 days of receiving your claim. However, the rules allow them to extend deadlines for reasons beyond their control, providing:
- They explain in detail within the initial timeframe why more time is needed
- They set a new deadline for a final ruling
If they require more information from you, they must give you up to 45 days to supply it. The insurer has up to 30 days after receiving the information to tell you when they expect to make a decision.
In some cases, insurers will say they need even more time (up to 30 additional days) after the first extension. Again, the onus is on them to notify you before the first extension expires about why it’s necessary and then set a new deadline.
Additional extensions are only allowed with your consent under ERISA laws. If you say “no,” they must make a decision by the end of the current deadline. If the insurer contends they do not have enough information, they will likely deny the claim.
You have the right to appeal denials
If your claim is denied, the insurer must include the reasons for the denial and inform you of your right to appeal. You typically have at least 180 days to file an appeal. Working with an ERISA attorney early on can help you through the process.
Experienced lawyers understand how to interpret LTD plans to determine if you are covered by your employer. They also know what insurance companies need to assess your claim adequately. Lastly, they understand how appeals work, which can be crucial for overturning a denial based on mistakes made in the initial claim or by the insurer.