Long-Term Disability Deadlines
Mason Waring: Hello, my name is Mason Waring. I am an attorney and partner at Chisholm Chisholm and Kilpatrick. I joined here today with my colleague, Attorney, Leah Small. We represent people in their long-term disability insurance claims with insurance companies. These are people who receive coverage through their employment or they bought insurance policies directly from the insurance company. They are disabled. They file the claim or their claim has been denied. They need to file an appeal or they need to go to court and we help them through that process. Today, we are going to talk about an important subject, deadlines. We get a lot of questions about deadlines, deadlines to file the claim when you are disabled, deadlines to file an appeal. If you file the claim and your claim was denied, and then deadlines when it is time to go to court when you are done with the administrative process with the insurance company. The next phase, if your benefits are denied, is to file a lawsuit in court. We are going to answer some of the basic questions here. Spoiler alert, the answer to a lot of these is read your policy, read the plan documents, understand the law in your jurisdiction. There are not many cookie-cutter responses to these questions, because it is going to depend on how your policies are written, how the plans are written, and where you are located in the country. But there are some important considerations that we are going to hit here that should give you some guidance and maybe direct you where to look to and understand some of those. This will give you a good… should give you a good mental model of the deadline framework here with the long-term disability claims. So, let us get started with the beginning. Leah, could you start us off by talking about deadlines to file the initial claim?
Leah Small: Sure. As you mentioned earlier, there is no one deadline that applies to all claimants for filing an initial LTD claim. It can vary from LTD plan to LTD plan. As you said, if you need to file an LTD claim, you should request a copy of your plan governing documents from your employer, or more specifically, the HR department often and read these carefully. These documents will explain what your coverage is, your benefit amounts, and importantly, what the deadlines are for sending notice of a claim to the insurance company, so letting them know that you are disabled and you need to file a claim as well as the deadline for filing, proof of claim or evidence of your disability with the insurance company. It is really important that you read this carefully because it is possible that if you miss these deadlines, you might lose your rights to these benefits.
Mason: Yes, it is tricky, sometimes when people are working while they are disabled, or they are no longer able to work. But they feel like they do not have time to file the claim, it can be a tricky situation because maybe you are really focused on your health. You do not want to wait too long, I mean, there are maybe instances where you want to wait for a test to come back, or you are really going to attend to your health, but time is not on your side here, and you want to get that claim files when you are ready. But as soon as you reasonably can, particularly if you do not think you have all of the policy or plan documents to fully understand things, depending on your jurisdiction, there could be some really harsh consequences in not meeting the deadline that you are required to meet. So that is, oh, sorry, Leah go ahead.
Leah: I was just going to add, we often see that a lot, especially with people who are planning to go back to work so they are unable to work now, but they plan to go back to work. A lot of times our clients will say, “Oh, I did not want to file the claim because I was planning to go back.” But then they are facing issues down the line where they are not able to return, and now they are late filing the claim and they are facing the potential loss of benefits or other, that is all.
Mason: That is a good point. It is something we commonly say, “Do not let your goals get in the way of reality today.” So many people, obviously, if you are not feeling well, there are many conditions where it could render you disabled for a period of time, but maybe at some point in the future, you will be able to go back to your same, or different work. That is a great and important goal to work towards, but if you are disabled today, get that claim in. Because you may be entitled to benefits for a limited period of time, and if you wait until you know whether or not you are able to go back to work that could be too late to file that claim for the initial period. So just really, time is not on your side with these claims. You want to be deliberate about it and make sure you understand your rights but do not delay or hesitate in making that claim. If you have questions, this can be tricky issues, talk to an inexperienced long-term disability lawyer, we advise people in this position all the time. So, people will reach out to us if they are working or newly going out of work and are contemplating making a claim. We help them get the documents that need to be reviewed, review them, and can counsel them based on their individual circumstances. That can be really helpful in making or doing some life planning and settling out what your, at least, immediate future looks like while you are trying to take care of your health. It costs nothing to reach out to us to see if we can help. So, please do not hesitate to do so. Moving on to timeframes for appeals. Now you have filed your initial claim, assume your claim gets denied. Then you need to engage in the administrative appeal process with the insurance company, particularly within a risk governed plan. Leah, tell us what those deadlines are.
Leah: Sure. Under ERISA, which is a federal law that governs most of the employer-provided long-term disability plans, the insurance company has, or a plan administrator or claim administrator has to allow you at least 180 days to appeal a claim denial or benefit, termination. Now, again, your plan documents potentially could provide for a longer time period. So, it is important to read those, but again, you have to be allowed at least 180 days. It is critical that you meet that deadline. Because if you do not, again, you can lose out your rights to these benefits. With that, it is not enough to just say, “I appeal by that deadline.” Usually, normally, you also have to get in all the evidence in support of your appeal that you want the insurance company to consider by that deadline as well.
Mason: The 180 days is pretty common, pretty standard, but there are absolutely exceptions to that. Particularly like in a life insurance context or health insurance context, and even the disability context, you need to be aware of shorter deadlines. Many professionals will have received Long-Term Disability coverage through their employer and maybe purchase their own insurance policy, sometimes from the same insurance company that the employer uses to provide long-term disability coverage. There can be different deadlines for filing claims and appeals of those different policies. So, you always, again, reemphasizing you need to get those, the policy documents, the plan documents and read them carefully to understand what your deadlines are because it could be less than 180 days. Leah, what is the consequence again for failing to file an appeal on time and in an arrest of governed claim?
Leah: If you miss that appeal deadline, that often is the end of your LTD claim and you will lose out on your rights to those benefits, no matter how disabled you might be.
Mason: It is critical to file your appeals on time. There are instances where you may need an extension to file an appeal. I would make sure that your extension is in writing confirmed by the insurance company if you did get one. You really need to deal with those carefully, if you are in that kind of situation, that is a great time to consult with a lawyer, really the appeal time filing that appeal, it is really important to consult with an attorney and try to get one involved on your behalf. For many people, it is often the last time, the last opportunity you will have to get substantive evidence into the record. In addition to having a really important deadline, you need to make with respect to the appeal. You also need to make sure you have gotten your evidence in the need to go to court if you need to do that. Moving next to the court, let us assume you file your administrative appeal and that is denied, the next step is often, court. Some insurance companies will offer a second-level appeal, some ERISA plans will as well. But you should assume that you get one appeal. You might get more, again, read your plan documents, read your policy, see what it provides. But let us assume you have exhausted your appeals. It is time to go to court. Leah, how long do people have?
Leah: Again, there is no one-size-fits law here. It can vary, LTD plan to LTD plan, and claim to claim. Many long-term disability plans contain a deadline for filing a lawsuit under that plan, and we call this the contractual limitation period. So again, review your plan governing documents carefully to see if your employer’s LTD plan has some deadline, because as with all the other deadlines we have discussed, if you fail to file the lawsuit in court by that deadline, you can lose your rights to your benefits. For a list of government claims that were filed after April 1st of 2018, if the insurance company denies your appeal in that denial letter, then you need to include the calendar date on which that contractual limitation period expires. The insurance company should tell you if you filed your claim after April 1st, 2018. But again, it is best to review your claim governing documents and review that deadline for yourself, to make sure you are meeting that deadline. If some LTD plans do not have that contractual limitation period in them, though, in those cases, generally, the deadline to file a lawsuit is governed by state law and the statute of limitations in that state. But again, that varies state to state. You have to know the law governing what state you are in, or potentially your LTD plan could say, “Extra state law applies” and then you might be dealing with that state law. So again, this can be complicated that you need to review your documents carefully. Make sure you understand what laws apply. This is an especially critical time to get a lawyer involved to make sure you meet these deadlines, because whether it is a contractual limitation period or the state statute limitations. If you miss it, again, you could completely lose out to your benefits.
Mason: Hopefully by this time, hopefully, you have got a lawyer involved during the appeal process. When we are handling an appeal for a client, if the appeal is denied, it is time to go to court. We sorted all this out for our clients and advise them on the recommended course of action. It is not always a clear answer, what state law applies in what statute limitation applies in or how the contractual limitation will apply? So, there is often a degree of judgment that we need to exercise and we do that for our clients to sort through these issues for you. Leah, what else, if anything, do we have to tell our viewers about deadlines today?
Leah: Once the appeal is submitted to the insurance company, they have 45 days to make a decision. However, they are allowed to take a 45-day extension if there are special circumstances that justify the additional time to process the appeal, like with initial claims, they have to send through written notice of the extension. That letter has to explain what the special circumstances are and identify the date by which they expect to be able to make a decision on the appeal. Again, if the insurance claim requires the extension because you failed to provide information to them and necessary for them to decide the appeal, then the time period is told or paused until they receive that information from you. Unfortunately, even with these requirements around taking extensions, it is not uncommon for insurance companies to assert that there are special circumstances requiring this additional time or extension when really they just have not reviewed the appeal in a timely manner. So, this is another instance where having a lawyer involved can be really beneficial because we are experienced, keeping an eye out for that and holding the insurance company to the requirement that there actually be special circumstances before they can just take an extension.
Mason: Yes, that is a great point, we track your deadlines. We do everything we can to get the evidence that the insurance company requires of you to the insurance company as soon as possible to eliminate those excuses of, “Hey, I am waiting for you claiming to provide me with information.” We do not rest and wait for the insurance company to do the data collection. We do it for you and submit packages with proof of what we sent when we sent it so we can hold them accountable for deadlines. Leah, is there anything else to add about deadlines today?
Leah: I think just one more time, deadlines are critical. If you do not need them, you can be putting your benefits at risk. So, make sure you read your, like I said, policy or plan governing documents and make sure you are meeting all the deadlines.
Mason: Yes, this is… it can get complicated and really feel overwhelming, really underscores why it is important to get an experienced long-term disability lawyer involved in your case. That is what we do, we are dedicated to that mission, to helping people make these claims and deal with the complexities of these cases. So, if you have a claim pending or thinking about making a claim, you need to make an appeal, feel free to reach out to us. We would be happy to speak with you and see if we can assist, it cost nothing to see if we can assist. Leah, thank you very much for all the great information today and I hope you have a great day.
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