In this video, Senior & Managing Attorney David Martin discusses three common questions he hears from clients regarding long term disability benefit claims.
Question #1: Once my long term disability claim has been denied, how long do I have to appeal?
Most often, clients will see in the letter that they have 180 days from the date of the letter to appeal the claim. That is only partially true. There is actually 180 days from the date that the letter is received. That is the minimum for appealing the claim.
However, you must look at the plan document to ascertain exactly how long the timeframe really is. A mere letter cannot revise the plan document. The adjuster may tell you that you have 180 days from the date of the letter, when actually, you have 180 days from the date that you received the letter, of if the plan document allows a longer time frame, you have the time frame in the planning document. That could be a year, where it might not even be mentioned in the plan document. In that event, a longer time frame above 180 days may indeed be applicable.
Question #2: How long until I file a lawsuit?
Generally, if there is no limitation of action provision in the plan document, then ERISA, which is the federal statute that governs many group long term disability claims, imports state law into the plan document. For example, in the state of Alabama, you would have six years from the date that your claim was denied to file a lawsuit.
Many plan documents, however, do have a limitation of action provision in them. And so, again, you have to carefully review your plan document to know exactly how long you do have. For example, many plan documents state that you have three years from the date proof of loss was required to be furnished.
That can be a little bit complicated to figure that out.
Does that mean the first time proof of loss was required to be furnished? Sometimes there is a 90 day limit for that. Sometimes there's a year limit for that. You may have three years and 90 days, or you may have four years.
There has to be a little bit of factual analysis that someone has to undertake. If you can't ascertain that yourself, an attorney who regularly handles ERISA matters is the best person to help you with that analysis.
Question #3: After I file the lawsuit, is the process over? Will they continue to pay the claim without any further problems?
No. The same lawsuit can end up being filed multiple times in a row.
I've had cases where I had to file the same lawsuit twice. It's not the same identical lawsuit. There may be six months or a year of benefits in between, but it's over the same long term disability claim.
That's extremely unfair to claimants, but that happens. And it happens because once the court makes a decision in the claimant's favor, the case is sent back to the insurance company, and only the benefits, either up to the court decision or past due benefits, are paid.
Then, going forward, the long term disability insurer has the right to review the claim again and make a decision again, so you could end up going to court multiple times over the same long term disability claim.
This can be very disheartening; however, we have come up with fee agreements that allow people to guard against that and we allow our clients that option.
Whether you or your client needs advice before applying for long term disability benefits or need help with a problem afterward, contact an experienced long term disability lawyer or ERISA disability attorney at The Martin Law Group at 800-284-9309 or www.erisacase.com.
As required by the Alabama Rules of Professional Conduct Rule 7.2, no representation is made that the quality of the legal services to be performed is greater than the quality of legal services performed by other lawyers. The information presented in this video should not be construed to be formal legal advice nor the formation of a lawyer/client relationship. Therefore, no information of any kind that you provide us before such a relationship is created is confidential or privileged.