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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