If you were working in D.C. and are applying for Long Term Disability benefits, here are deadlines to follow.

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What is the Timeline for Pursuing an ERISA Long-Term Disability Claim Then Filing An Appeal?

If you have a disability that has left you unable to work, you will want to file a claim for disability benefits. Often, employers provide long-term disability benefits to help make sure employees maintain a basic level of income until they can return to work – if returning to work is possible. If you haven’t filed for long-term disability, you may not be aware of the process or the timelines to get a claim underway.

The Employee Retirement Income Security Act (ERISA) regulates the responsibilities of those who manage and administer any employee disability benefit plans that are provided by employers. ERISA, which was created to protect workers, has strict rules for both insurance companies and employers to adhere to, including the review of applications and deciding whether a claim should be approved. These guidelines also oversee appealing any denials of claims.

What Happens After You Have Applied For ERISA Disability Benefits?

After you have applied for long-term disability benefits through ERISA, the insurer has up to 45 days to either deny or approve the application. The insurer, however, can delay this process with reason for as long as 30 more days by asking for an extension.

If the insurance company needs more information from you, you have 45 days to respond with those details. After the insurer has received the information they requested, they have only 30 days to decide. If the insurer doesn’t need more information, you could have a decision within 45 days. If there are reasons for a delay and the insurer requests more details, it could take several months to have a claim approved or denied.

What Happens If Your Claim Is Denied?

After you have received a determination and your benefits were denied or terminated, what do you need to do?

You have up to 180 days to get an appeal filed. ERISA requires you to meet this deadline, and if you don’t meet the deadline, you have no further legal recourse and will not be able to receive disability benefits. If your claim has been denied, you need the help of an ERISA disability attorney.

If you meet your deadline and get your appeal filed, your disability benefits company will consider your appeal.  If they deny the appeal, you can ask for judicial review of your claim in federal district court - that means filing a federal lawsuit. The court is generally only allowed to review the information provided in the insurance company files - which is everything you put into your appeal. If information isn’t available in the file, the court will not be able to review it. Preparing your disability appeal is critical.

That's why you need an attorney who understands how to prepare your appeal - the medicine, the vocational expertise, the additional evidence you will need to get your benefits reinstated.  Everything that is done from this point on should be done considering there is a possibility for litigation. 

So don't hold anything back, thinking you can surprise the insurance company or convince a federal judge you should be getting long term disability benefits - the judge probably won't be able to consider evidence that is not in your appeal.

And don't wait - that 180 days is a real time line and you and your disability lawyer have a lot of work to do!  So if you've been denied or your disability benefits were terminated, call us today at (202) 393 - 3320. 

Frank R. Kearney, Attorney-at-Law
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Experienced DC Workers' Comp, Long Term Disability & Accident Lawyer