Know your limits!
Written by Kantor and Kantor insurance Matters on November 17, 2013
Dealing with chronic illness can invite many new challenges, including the delicate task of communicating with your insurance company. Communicating effectively with an insurance company often involves persistence, patience, adhering to the rules under your Plan, and knowing how to advocate for the benefits to which you are entitled.
One task, often mistakenly overlooked, is the deadline to appeal a long term disability insurance denial. It is not uncommon to find very strict time limitations for appeals, as well as for filing suit after the administrative appeal period has expired. If you do not stick to these deadlines, you will forfeit your right to pursue an appeal or take legal action. After you receive a denial letter for your long term disability claim, the clock immediately begins ticking. Don’t lose valuable rights because you aren’t aware of the applicable time limitations!
Now that you are aware of this issue, you are most likely wondering, how do I know what the critical time limits are?
- Request a copy of your policy from either your insurer or your employer. Your policy will tell you what you need to know so that you can comply with any deadlines. Please note that most insurance policies require the claimant to submit proof of disability within a specific period of time after the onset of disability. Be sure that you follow this rule.
- Check the language of your denial letter. Your denial letter might specify that you have a maximum number of days to appeal an adverse determination regarding your disability claim (usually 180 days, but possibly as short as 30 days).
- If your long term disability coverage is group coverage, and was provided by the employer, it is probably governed by ERISA (Employee Retirement Income Security Act), federal Common Law and Department of Labor regulations governing ERISA claims.
The Federal Regulations governing ERISA mandate that the employee participant in a group plan be given a minimum of 180 days to appeal a first denial or termination of benefits.
- If the coverage was purchased independently, and is individual coverage, the insurance company's obligations will be governed by the California Insurance Code, California contract law, and the implied covenant of good faith and fair dealing. In this case, time limits will be governed by the language of the policy, and state statutes governing statutes of limitations for filing legal actions.
After a long term disability insurance denial, and if an administrative appeal is required (as in ERISA claims) it is certainly possible for you to deal with the appeal on your own. However, managing an appeal on your own can be risky if you are not physically or mentally capable. If the case becomes too complicated, or you are having trouble making sense of your policy, you may want to seek out advice from a professional.
For a no-cost consultation, or even just a referral to a lawyer in your area, contact Kantor & Kantor at (800) 446-7529 or find us at www.kantorlaw.net.
We understand, and we can help.