Missing a deadline in your ERISA claim is deadly to your claim.
Accordingly, it is extremely important that any and all deadlines are met. One deadline of particular importance is the 180-day deadline by which to submit an appeal of a denial of benefits covered by ERISA. The federal regulations that govern ERISA require insurance companies to allow claimants 180 days to submit an appeal of a denial of benefits. While the regulations state that the claimant is to be allowed 180 days from the date of receipt of the denial, the safest course of action is to calculate the deadline from the date of the letter denying the benefits. This is one of many good reasons to come to Kantor & Kantor with your claim.
Six Months Will Fly By
Another consideration for timeliness is how quickly after the denial you get the help of an attorney. While six months (180 days) may seem like a long time, in the life of an ERISA appeal, it goes by surprisingly fast. For example, you (or your attorney) will need your claim file in order to properly prepare your appeal. Under the federal regulations, the insurance company has 30 days from the date you request your claim file in which to provide it. Now you are already down to five months, assuming you made the request immediately upon receipt of the denial letter. Then, your attorney has to review your claim file, which, depending on the nature and age of your claim, can be 1,500 pages or more. This review is crucial to the appeal because it allows the attorney to see the reports and documents the insurance company used to deny your claim.
Next, you must gather evidence in support of your appeal. Typically this is medical and vocational evidence. In some cases, it might require examinations by experts. Doctors and other experts have busy practices. Getting appointments to see experts, gathering records and getting reports all take more time than one might realize. The receipt of this evidence is largely outside of your (or your attorney’s) control. Before you know it, you are approaching the appeal deadline.
The sooner you retain an attorney to help you with your appeal, the better. The more time an attorney has to work on your case, the stronger your appeal will be. Please note by no means are we suggesting you rush to choose an attorney. Instead, we are suggesting that you get your search going as soon after you receive your denial letter as possible.
For more information on the appeals process, please contact one of our attorneys for a free consultation at 800-446-7529 or use our online contact form.