Employer-provided long-term disability insurance is governed by the Employee Retirement Income Security Act (ERISA), which requires both employers and employees to comply with specific procedures and time limits when filing claims for benefits. Filing a claim while adhering to all of these requirements can be difficult, so if you were recently injured in an accident or diagnosed with a debilitating condition, it is crucial to retain an experienced long-term disability attorney in Chicago who can ensure that you file your claim by the appropriate deadline.
Before filing a claim, it is important for a claimant to review the summary plan description (SPD), which each policyholder should receive from their employer. SPDs provide a detailed overview of the coverage provided by the plan, including:
The SPD will also outline the plan’s definition of disability and give claimants an idea of the evidence that they will be required to submit in order to prove disability. It is important to check the SPD before filing a claim as each company’s claims procedures may be subtly different. For instance, the SPD will tell claimants:
Once a claim has been submitted, the insurer must provide an answer to the claimant within 45 days of receipt. Although the plan’s administrator can extend this deadline by up to 30 days, he or she must do so before the end of the 45 day period and explain the reason for the delay. If further information must be submitted, the claimant has an additional 45 days from the date of the request to provide it. The claim must then be decided at least 30 days after the additional information was supplied. Private insurers who are not required to comply with the terms of ERISA may have alternative deadlines, so it is critical to check with your plan’s administrator before filing a claim.
Coverage is denied to qualifying policyholders on a regular basis. Some of the most common reasons include:
Fortunately, policyholders who have had their claims denied can appeal the decision. Policies that fall under the purview of ERISA require claimants to go through a series of administrative appeals before they can file a claim in court, while policyholders whose coverage is provided by a private insurer can file a claim in state court almost immediately.
If you are an Illinois resident and are unable to work as a result of a disability or medical condition, please contact us at Bartolic Law.