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An ERISA Disability Appeal Must Be Filed Timely or You Will Have No Right to Sue

  • Synopsis: Published: 2013-02-12 (Revised/Updated 2016-03-20) - It is essential that you file an ERISA appeal timely if you received a denial of group short-term or long-term benefits by your disability company. For further information pertaining to this article contact: Disability Attorneys Dell & Schaefer at diattorney.
ERISA

ERISA - The Employee Retirement Income Security Act of 1974 (ERISA) is a federal law that sets minimum standards for most voluntarily established pension and health plans in private industry to provide protection for individuals in these plans. In general, ERISA does not cover group health plans established or maintained by governmental entities, churches for their employees, or plans which are maintained solely to comply with applicable workers compensation, unemployment, or disability laws. ERISA also does not cover plans maintained outside the United States primarily for the benefit of nonresident aliens or unfunded excess benefit plans. ERISA does not require any employer to establish a pension plan. It only requires that those who establish plans must meet certain minimum standards. The law generally does not specify how much money a participant must be paid as a benefit.

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Quote: "Insurance companies are banking on claimants' lack of understanding of these rules in hopes that the deadlines will be blown and the insured will have no recourse."

Have you received a denial of group short-term or long-term benefits by your disability company? It is essential that you or your disability attorney files an ERISA appeal timely.

On a regular basis, the law firm of Dell & Schaefer receives calls from claimants who have failed to file their ERISA administrative disability appeal within the required 180 days. Unfortunately, under ERISA regulations, once the 180 day time limit has expired the insurance company is not required to accept your appeal. If your insurance company refuses to accept the untimely appeal, your claim will be closed and you may have waived your right to bring a disability denial lawsuit against them to recover the money you are rightfully owed. This can be very frustrating and disheartening to claimants who are relying on this income to support their families.

WHAT IS AN ERISA DISABILITY APPEAL AND HOW WILL I KNOW WHEN MY ADMINISTRATIVE APPEAL IS DUE

If you have a group disability policy provided by your employer chances are it's governed by federal law under an act called the Employment Retirement Income Security Act of 1974 (ERISA). Your rights under ERISA are more restricted that those under state law. When your benefits have been denied or terminated it is critical to be aware of the strict deadlines that must be adhered to. Insurance companies are banking on claimants' lack of understanding of these rules in hopes that the deadlines will be blown and the insured will have no recourse. If your benefits are denied, ERISA requires that you file an administrative appeal directly to the insurance company. This is your only opportunity to present your case as once the administrative record is closed (after the expiration of 180 days) nothing else may be added no matter how critical the information may be. Some short term disability policies require an appeal to be submitted within 60-90 days of denial. If you end up in a court of law, the only information the judge will consider is information that was provided during the appeals process and nothing else.

When you receive a letter from your insurance company, it will contain language similar to the following: You may appeal this decision by sending a written request for appeal to us within 180 days after receipt of this denial letter. In the event the appeal is denied in whole or part, you will have the right to bring a civil action under Section 502(a) of the Employee Retirement Income Security Act of 1974.

To help ensure you prevail and receive the benefits rightfully owed to you, it is pertinent to be aware of and calendar the deadline to submit your appeal and contact an attorney specializing in ERISA disability cases to assist in preparing your appeal. There are numerous strategies that you must be aware of when filing a disability appeal. The disability attorneys at Dell & Schaefer have represented thousands of disability insurance claimants throughout the country and always offer a free consultation to discuss your disability insurance denial.

About the Author: Gregory Dell is a nationally recognized disability insurance attorney representing disability insurance claimants at all stages of a claim for either short term or long term disability benefits. Mr. Dell and his team of lawyers represent disability claimants nationwide and have handled claims against every major disability insurance company. Mr. Dell has an author of a text book on disability insurance claims and he is Vice Chair of the American Bar Association Health and Disability Insurance Law Committee.

Related Information:

  1. Why Should I Hire a Disability Attorney to Submit My ERISA Appeal - If your claim has been denied through ERISA group policy the most important part now is the actually filing of your appeal - (Published 2010-09-16).
  2. Can I Sue My Long Term Disability Insurance Company for Bad Faith or Punitive Damages - The answer to this depends upon whether or not you have a claim governed by ERISA or you have an individual disability policy - (Published 2010-09-21).
  3. Different Definitions of Disability for Insurance Claims and ERISA - A recent disability insurance claim case may change the landscape of disability claims brought under the Employee Retirement Income Security Act - (Published 2012-08-18).


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