Long Term Disability Benefits — Frequently Asked Questions (LTD FAQs):
Is my claim governed by ERISA?
If you are covered by a Group Long Term Disability Policy through your employment, your claim is probably governed by ERISA. However, church and governmental (including most City and University) employees are exempt from ERISA.
How long do I have to appeal an adverse decision?
ERISA provides a 180-day deadline in which to a file a first level appeal. Some LTD policies provide for a second level appeal, and the deadline is often shorter than 180 days.
How long do I have to file suit after appeals are exhausted?
Most LTD policies contain a deadline in which legal action must be taken. This language is usually toward the back of your LTD policy. We typically see policy deadlines of 1 to 3 years, but United Parcel Service’s LTD policy deadline is 6 months (and that has been enforced by the Courts). If there is no policy deadline, the deadline varies from state to state.
What about my State’s Department of Insurance?
If your claim is governed by ERISA (federal law), all state law is pre-empted and your State’s Department of Insurance has no jurisdiction. However, many insurance companies include language in their denial letters telling the insured that, if they wish, they can file a Complaint with their State’s Department of Insurance. This is true, but doing so is a waste of time. You will receive a response a few months later that the Department of Insurance lacks jurisdiction, and your appeal deadline will be that much closer (or expired).
Why should I appeal to the same insurance company that has already denied my claim once?
You are required to exhaust all mandatory internal appeals. If you file suit without exhausting the internal appeals process, your suit will be dismissed. By then, your appeal deadline might have expired.
Can I sue for bad faith or punitive damages?
If your LTD claim is governed by ERISA, the answer is no. ERISA is a federal law that pre-empts state law claims such as bad faith and punitive damages. You can only sue for the benefits due.
Do I need a lawyer?
ERISA is a framework of complex federal laws, regulations and case law. Most attorneys do not have the knowledge or experience to properly handle an ERISA governed LTD appeal or lawsuit. We regularly see general practice attorneys who have missed deadlines or failed to address critical issues. Unrepresented claimants risk doing the same.
When should I hire a lawyer?
A claim for Long Term Disability insurance benefits is won or lost at the appeal stage. Once the internal appeals have been exhausted and the suit is filed, no new evidence can be introduced. There are no trials, hearing or depositions. The Court simply reviews the claim file, often with the mindset that it should defer to the insurance company’s decision. It is essential that a qualified LTD attorney reviews the claim file at the appeal stage and determine what additional medical and/or vocational proof needs to be added and what adverse information needs to be rebutted.
How long does an appeal take?
The insurance company has 45 days after it receives your appeal in which to make its decision, which can be extended by an additional 45 days if such election is made in writing within the first 45 days.
Why hire Evensen Law Office?
We are dedicated to excellent client service and outstanding results. Our LTD team consists of two attorneys, a paralegal and an office manager, working together and in concert to deliver the highest level of legal representation. The Evensen Law Office team is headed by attorneys Erik Abell and Chris Evensen, who have over 15 years of experience.
If you have questions that are not covered in these LTD FAQs, call us at 1-888-978-4048 (toll-free) or 502-587-1983. Free initial consultation. Or e-mail us at erik@evensenlawoffice.com.
