In ERISA long term disability cases there are a number of deadlines. Missing any of them could be fatal to your claim.
>Providing Proof of Loss – Most insurance policies will have a deadline for providing proof of your disability. Some require that you submit proof as soon as you know of your injury/illness or disability resulting from those. Others may extend the time period up to a year from when you became disabled. Failure to notify your insurance carrier in a timely manner could result in a denial of your claim.
I see this often when a disabled individual has another claim such as a workers compensation claim and they fail to put the disability insurance carrier on notice of their disability because someone told them they could not collect both workers compensation and disability. Waiting to notify the disability carrier until the WC carrier stops paying or after settling the WC claim is often too late. Knowing what your policy requires is the key.
>Filing Administrative Appeal – When you receive a denial letter, one of the first things to look for is your time frame for filing an appeal. This is important because ERISA laws require a claimant to exhaust their administrative remedies before filing a lawsuit. Failure to exhaust the administrative remedies may result in a dismissal of a subsequently filed suit. Generally speaking, the policy requires an appeal within 180 days of receipt of the denial. Keep the envelope the denial came in. This will help establish when the denial letter was mailed.
> Statute Of Limitations – The laws of ERISA do not set a specific statute of limitation. However, often the disability policy will. The courts will generally uphold it if it is reasonable. If the statute of limitation is not listed in your policy, the court will look to your state law governing contracts.
