What Is the Statute of Limitations for Long-Term Disability ERISA Claims?

What Is the Statute of Limitations for Long-Term Disability ERISA Claims

When you have a long-term health condition that keeps you from working, you may feel overwhelmed by medical appointments and treatments. In addition to dealing with this life-altering situation, you may also feel confused by the different deadlines involved in filing for your employer’s long-term disability insurance. 

Long-term disability insurance provides income replacement when you have a long-term health condition that prevents you from working. You certainly need the replacement income, but you wonder what is the time limit or statute of limitations for long-term disability ERISA claims

If you’re applying for a private employer-provided long-term disability (LTD) benefit, the federal Employee Retirement Income Security Act of 1974 (ERISA) likely regulates the plan. ERISA sets standards covered plans must meet, including rules for setting a time limit or statute of limitations for a disability claim. Plus, ERISA regulates the appeal and civil lawsuit time limits if your claim is denied.

ERISA Long-Term Disability Insurance Definition

Before we discuss the statute of limitations for long-term disability ERISA claims, you must first understand which long-term disability plans are covered by ERISA. ERISA governs private employer-provided long-term disability insurance. If you work for a federal, state, or local government or church, ERISA does not cover your employer-provided long-term disability insurance. The same is true if you purchased long-term disability insurance on your own. 

Statute of Limitations for an ERISA Long-Term Disability Claim

A statute of limitations is the maximum amount of time a person has to pursue a legal claim. The statute of limitations for an ERISA claim for benefits would likely begin running on the date of the injury or health condition diagnosis.

First: Look at Your Long-Term Disability Plan Documents

Each ERISA long-term disability (LTD) plan sets its own statute of limitations for filing a claim, appealing a denial, and bringing a lawsuit to court. The plan must comply with ERISA’s minimum standards; otherwise, these time limits vary from plan to plan. 

Thus, the first step in determining the statute of limitations for ERISA LTD is to look at your long-term disability plan documents. Under ERISA, your employer must provide you with the summary plan description (SPD), which includes the time limit for filing a claim, appealing a denial, and filing a lawsuit. Be sure to confirm all deadlines with the full plan document.

ERISA Minimum Time Limits for Filing a Claim

The time for filing an initial claim for benefits varies. You should immediately ask your employer for a copy of the SPD and the plan documents to confirm the claim filing deadline. An insurance carrier must decide on your claim within 90 days unless there are special circumstances. 

ERISA Minimum Time Limit for Filing an Appeal 

Unfortunately, an insurance company may deny your claim wrongfully. Your insurance carrier may have a one- or two-step appeal process. This means that either the decision on the first appeal is final, or you can appeal to a higher body within the insurance company if they deny your first appeal. Look for this information in your plan documents.

ERISA requires insurance carriers to state the time limit for filing an appeal when they deny your claim. The minimum time limit they can set for this appeal is 180 days. This also applies to second-level appeals. You should review your plan documents and the denial letter to ensure you don’t miss this deadline. Otherwise, you may lose your ability to pursue long-term disability insurance. 

Appeal Response Time Limit

Your insurance carrier has 45 days to respond to your appeal. They may extend that period for an additional 45 days but must state why in writing. Please note, however, that long-term disability insurance provided under collectively bargained plans (union plans) may have different response times. 

Time Limit for Filing a Case In Court

Unfortunately, sometimes an insurance company denies your appeal. Unless the insurance company has a second-level appeal (as described in your plan), your only recourse is to file a lawsuit. Fortunately, under ERISA, you can sue an insurance company to recover benefits due to you under a long-term disability plan. 

As with filing a claim and an appeal, there is a time limit for filing a lawsuit after your appeal. The insurance company can set this time limit, as with other ERISA-covered long-term disability plan time limits, so long as it’s reasonable. When an insurance company denies your appeal, they must state in the denial letter the date by which you must file your lawsuit.

An Experienced ERISA Attorney Can Help Appeal Your Long-Term Disability Claim

Navigating the different time limits for your long-term disability claim requires sifting through documents and understanding the details of ERISA. You need an experienced advocate who can guide you through this complicated process. Our skilled ERISA attorney at the Peace Law Firm is here to help you through this process so you can focus on your health. Contact us today.

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