Over the next few weeks, we'll be discussing five mistakes individuals make when filing ERISA claims for long term disability and short term disability, life insurance, pension or retirement, and sometimes large medical benefit claims.
The second mistake is missing deadlines.
Most people are familiar with the fact that claims can get too old. For example, you have to file a lawsuit on an auto accident case within two (2) years of the date of the accident. In the state of Alabama, you have to file a breach to contract claim within six (6) years of the date of the breach.
There are lots of time limits in filing a lawsuit, but ERISA claims are more challenging because they have pre-lawsuit time limits that can make your case worthless if you do not follow them.
For example, with a life insurance claim or a pension/retirement claim, you only have 60 days to appeal the denial of the benefit. During that 60 day time period, there's a lot of work that has to be done to ensure that your appeal is strong.
With claims involving disabilities such as long term disability claims or pension claims that involve a pension disability, you have 180 days (at a minimum) from the date you receive the refusal to pay a claim to present an appeal. The plan document can enlarge these time limits, but the claim regulation issued by the Department of Labor, which applies to ERISA claims, provides the floor or the bare minimum
which the plan must allow.
Though the time period is longer for claims involving disabilities, a lot of work still must be done during that six month time period in order to provide an effective appeal. An appeal is not simply just a letter asking the insurer to reconsider your claim denial.
If you miss those deadlines, what is the harm?
The court may find that you have failed to exhaust claim remedies, causing denial of any right to file a lawsuit. This can be tantamount to missing a statute of limitations. There are ways around that and exceptions, but you have to be an experienced ERISA attorney to know how to navigate those issues.
Whether you or your client needs advice before applying or appealing for ERISA benefits such as long term disability, short term disability, life insurance, pension and retirement, contact an experienced ERISA attorney at The Martin Law Group at 800-284-9309.