While every Long Term Disability policy and plan is different, they all impose deadlines that a claimant has to meet to file for disability benefits, to appeal a denial of those benefits, and to file a lawsuit once you have gone through the pre-suit claim process (what insurance companies call "exhausting administrative remedies").
When you first stops working because of a disability, you must apply for disability benefits and provide proof of your disability (i.e., medical records, vocational records, performance reviews that comment on your inability to do the job, "buddy letters" from friends or co-workers that know you and have observed your limitations, etc.). The deadline that applies to filing for benefits and providing proof of that disability can usually be found under the heading "Proof of Loss" in you policy or company's disability benefit plan. Policies and plans will require that you submit you application and proof of disability anywhere from within 30 days to up to a year after the date you stopped working. If you do not notify your insurance company within that deadline, the insurance company could deny your claim.
If your benefits are denied, or paid and then terminated, you will be provided a chance to appeal that decision. Again, different policies and plans have different deadlines, as well as a different number of times you may appeal before filing a lawsuit. Most employer benefit plans allow 180 days from the date of the denial/termination letter to file an appeal. Individual disability insurance policies may not offer an appeal or may offer a very short appeal window of 30 or 60 days. Read your policy or plan to find our your deadline.
NOTE: If you did not receive your denial letter until much later than the date on the letter, look at the date on the envelope to determine if the letter was sent on the same day that the letter was written. If not, keep the envelope as proof that the insurance company delayed mailing this letter, as this may give you more time to gather the evidence you would like to submit for an appeal.
It is important to understand that your policy or plan may require one or more appeals before you file a lawsuit, so do not think you can skip that process. Missing the appeal deadline may cause you to lose your claim forever.
Once you have gone through the pre-suit appeals, you may file a lawsuit. Your plan or policy may state how long you have to appeal. If it does not, your state law will determine the statute of limitations to file a lawsuit. If you miss this deadline, you will lose your right to file a lawsuit to recovery your benefits forever.
REMEMBER: Read your policy or plan thoroughly to determine what deadlines apply to your particular claim. Failure to meet those deadlines could result in the denial of your claim. If you are not sure what deadlines you must meet, consult with an attorney who specializes in disability cases. We recommend consulting with a disability benefit attorney from the beginning of your claim, but you should certainly contact an attorney if your claim has been denied before you file an appeal.
Copyright (c) 2008 by John V. Tucker and Tucker & Ludin, P.A. All rights reserved. For a free consultation about your Long Term Disability claim, ERISA Disability benefit claim, Social Security Disability claim, or Veterans Disability compensation or pension claim, call Disability Lawyer John Tucker Toll Free at (866) 282-5260.
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