You don’t expect to have an illness or injury leave you unable to work. But if something does happen, you may have long-term disability (LTD) protection to protect lost wages. Check with your employer to see if you have LTD, either because the employer provided it to you at no charge or you purchased as an optional employee benefit. This type of coverage through your employer will ensure that a disability doesn’t leave you without a paycheck.
But like many people who apply for LTD benefits, you may receive a denial. If so, federal law regulates how your insurance company (or the plan administrator) reviews your application and gives you the ability to appeal.
ERISA puts time limits on your insurer to respond
If your employer makes LTD insurance available to you, the Employment Retirement Income Security Act (ERISA) regulates claims and denials. Your insurer must follow specific rules when processing your claim.
When you first apply for benefits, the insurance company must respond within 45 days, although two 30 day extensions are permitted under some circumstances. If your claim is denied, it must provide you at least 180 days to appeal the decision.
The insurer must provide you with all documents explaining your denial
In addition to responding in a timely manner, your insurer must explain why it denied the claim. This explanation must point out specific parts of the policy that exclude you from benefits. It must also include the reason why the insurer disagreed with your doctors.
In addition to the explanation, you can request all documents related to your claim free of charge. These records may help you when you file your appeal.
ERISA lets you appeal a denial
Once you have all the reasoning for your denial, you can appeal the decision. Under federal law, the insurer must give your appeal to someone who didn’t work on your original claim. You can also submit additional documents to support your case. Actually, if ERISA governs your claim, the internal review request (or appeal) is mandatory. The appeal can also be the most important step in the entire claim process. It is extremely important you handle the appeal the right way. The assistance of a qualified attorney can make all the difference.
As with the original claim, the insurer has 45 days to respond to your appeal. And if they choose to deny it again, you can file a lawsuit and ask a judge to review the claim.
Many denied claims eventually become approved
When you need LTD benefits to supplement your lost income, a denial can be devastating. But your insurer may try to deny you even if you have a legitimate claim. We see insurers deny legitimate claims all the time at McDermott Law LLC. An appeal or a lawsuit may help you receive the benefits you need. Contact us to see if we can help.