If you are denied long-term disability (LTD) benefits, or if they are terminated, it is imperative that you address the decision immediately in order to protect your rights.
Normally, LTD benefit plans give you the right to appeal a denial or termination of your benefits. The “appeal” actually is an internal review by the LTD insurance company or other plan administrator. There are very specific deadlines which must be followed exactly. IF YOU MISS AN APPEAL DEADLINE YOUR CLAIM FOR LTD BENEFITS COULD BE LOST FOREVER.
Can't I just sue the insurance company?
Most appeals are mandatory. In other words, IF YOU FAIL TO APPEAL WITHIN THE TIME PERIOD ALLOWED, NORMALLY YOU CANNOT GO TO COURT AFTER AND ASK THE COURT TO REVERSE THE DENIAL OR TERMINATION OF YOUR BENEFITS. LTD plans may provide for either one or two of these internal appeals to the insurance company or other plan administrator. Again, each plan is different, it is, therefore, important to contact BEEDEM LAW as soon as your LTD benefits are denied or terminated.
Under ERISA, normally you have 180 DAYS after you receive the letter or notice informing you that your LTD benefits have been denied or terminated in which to make your first appeal. If a second level of appeal is available, you need to find out what the time limit is under your LTD plan and treat it very seriously.
As stated earlier, EACH PLAN IS DIFFERENT. Some appeals periods can be as short as 60 DAYS. It is very important to check the exact provisions and time limitations of your LTD plan.
How do I prepare for an appeal?
This is arguably the most important part of the process. IT IS EXTREMELY IMPORTANT TO COLLECT ANY AND ALL MEDICAL RECORDS, DOCTORS’ REPORTS, VOCATIONAL REPORTS AND PHYSICAL AND MENTAL EVALUATIONS THAT YOU WANT TO BE CONSIDERED AND SUBMIT THOSE WITH YOUR APPEAL.
If your claim is governed by ERISA, it is very likely that you will not have an opportunity to submit additional documents or other evidence in support of your claim after the appeal process is complete (in other words, after the LTD insurance company or other plan administrator has finished its internal appeal process). Obtaining and submitting all evidence with your appeal is especially important if you ever want to go to Court and ask the Court to reverse the denial or termination of your benefits. In most cases, a Court will not look at or consider any documents or other evidence that was not submitted to the insurance company or other plan administrator during the internal appeal process.