Tight deadlines in ERISA long term disability insurance claims keep lawyers up at night. I often counsel my clients about the importance of meeting the deadlines in their long term disability benefits claim. For example, if your long term disability claim is denied, you may only have 180 days (or about 6 months) to file your internal appeal. That might seem like plenty of time, but consider what steps need to happen in that time period:1. Gather all necessary medical records and other pertinent documents;
2. Take statements from any potential witnesses;
3. Obtain an expert opinion from your doctor;
4. Receive other expert reports, including functional capacity evaluations or vocational reports; and
5. Draft the appeal.
Additionally, if your long term disability claim has been denied on appeal, you may have only a short period of time during which to file a lawsuit. For more information about these deadlines, please see Attorney Schroder’s blog post. If you have a denied long term disability claim, please do not delay in contacting an attorney, as time is of the essence.
But there is a flipside to these tight deadlines. ERISA requires that the long term disability insurance carrier decide your appeal within 90 days after it receives the appeal. If it does not, you will be allowed to move your claim into court without waiting for a decision from the insurance company. Additionally, in some circumstances, the court may provide you with an advantage based on the long term disability insurance carrier’s failure to respond to your appeal on time.
Normally, at court, you will be required to prove not only that you are disabled, but that the long term disability insurance company’s denial was “downright unreasonable.” This means you will need to show no reasonable person would have denied your claim for long term disability benefits - a daunting challenge, to say the least. However, if the long term disability insurance company fails to decide your claim within the 90-day period, some courts have held that you only need to prove you are disabled as defined by the long term disability insurance plan. Further, you may be able to introduce evidence that otherwise would not be allowed.
An experienced long term disability attorney will monitor all deadlines in your case – not only to make sure none of your deadlines are missed, but to ensure the long term disability insurance company meets its obligations to you. For a free consultation, please contact me today to discuss your long term disability claim.