Benefit Claims Procedure

Keep in mind that if your long-term disability claim or ERISA case goes into litigation at a later time, the judge will look back at your claim record. A proper claim record may not be able to be put into place after suit is filed for benefits. From the beginning, you must follow prescribed procedures for making a claim as well as for appeals or requests for review in order to preserve your rights. Adhering to the rules at the early stages of your claim and appeal may well make the difference between success and failure in a lawsuit down the road.

Your long-term disability insurance plan or policy should spell out when a claim must be filed. This is also true of other benefit claims. The Employee Retirement Income Security Act of 1974 (ERISA) regulations regarding time frames are highly technical. The benefits claims procedures are set out in federal regulations (29 C.F.R. § 2560.503-1) and can be summarized as follows for disability claims:

  • A long-term disability insurance company has 45 days to accept or reject your claim.
  • The insurance company can inform you within that 45-day period that it needs a 30-day extension for a good cause.
  • The company may request yet another 30-day extension during the first 30-day extension.
  • All in all, the insurance company may take up to 105 days to make a decision on your case.
  • If the company requests information from you during the claim process it may seek to prolong the 105-day period even more.
  • If your claim is denied, you must appeal or request a review within the time period in the policy or plan, which must be at least 180 days for a disability plan.
  • After a claim is denied, you should consult with an attorney as soon as possible to maximize your chances for a successful appeal.

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