Claimants with Denied Disability Benefit Claims Get Extra Time to Appeal due to COVID-19

On April 28, 2020, the U.S. Department of Labor’s Employee Benefits Security Administration (EBSA) issued deadline relief and other guidance under Title I of the Employee Retirement Income Security Act of 1974 (ERISA) to help, among other groups, disability plan participants who are impacted by the COVID-19 pandemic, also referred to as the coronavirus outbreak.

The Department of Labor, Department of the Treasury, and the Internal Revenue Service issued a joint notice explaining the extension of time frames for healthcare coverage, portability, and continuation of group health plan coverage under COBRA, and time frames to file a benefit claim or appeal of denied claims.  They also issued COVID-19 FAQs for Participants and Beneficiaries that address a number of common questions concerning health and retirement benefits.

The final rule published by EBSA and submitted to the Office of the Federal Register (OFR) for publication contains information of the extension of certain timeframes under ERISA and the Internal Revenue Code for group health plans, disability and other welfare plans, pension plans, and participants and beneficiaries of these plans during the COVID-19 National Emergency.

We have received many inquiries from clients with denied short-term and long-term disability benefit claims because the pandemic has resulted in many cancelled or postponed doctor appointments.  Ordinarily, an ERISA plan administrator must give a claimant at least 180 days to submit an appeal of a denied disability claim.  But as shelter-in-place orders took effect in mid-March, claimants with denied claims have endured more than six weeks (and counting) of not being able to get non-emergency treatment.  In some situations, this has presented hurdles in getting evidence to submit with an appeal.

The final rule provides relief for claimants in this exact situation.  It extends the date under the ERISA regulations within which individuals may file a benefit claim under the plan’s claims procedure and the date within which claimants may file an appeal of an adverse benefit determination under the plan’s claims procedure.  Specifically, all disability plans must disregard the period from March 1, 2020 until sixty days after the announced end of the National Emergency or such other date that may be announced in a future notice (the “Outbreak Period”).

Based on an example in the final rule, below is an illustration of how the extension impacts the internal appeals process.  For purposes of this example, we will assume that the National Emergency ends on April 30, 2020, with the Outbreak Period ending on June 29, 2020 (60 days following the end of the National Emergency).

Jane Doe received a denial letter from Cigna (Life Insurance Company of North America) dated January 28, 2020.  Cigna informed her that she must file an appeal within 180 days of the date that she received the letter.  What is Ms. Doe’s appeal deadline?

When determining her appeal due date, the “Outbreak Period” is disregarded.  Therefore, Ms. Doe’s last day to submit an appeal is November 24, 2020.  To get to this date she takes the 180 days and subtracts 32 days.  This is because from January 28 (date of denial) to March 1 (declaration of National Emergency), she had 32 days to prepare her appeal.  That leaves a balance of 148 days.  She then adds 148 days after June 29, 2020 to get to November 24, 2020.  In this scenario, as long as Ms. Doe submits her appeal by November 24, 2020, Cigna must accept it as timely.

This extra time will greatly assist many claimants who are unable to visit their doctors in person.  However, if you have a denied claim, it is important that you consult with a knowledgeable ERISA attorney about your rights.  The employee benefit attorneys at Kantor & Kantor, LLP have helped thousands of disability claimants secure their benefits.  For a free case evaluation, please contact us at 877-783-8686 or use our online contact form.

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