The LTD Claim Process

What to Expect: The Long-Term Disability Claim Process

The Employee Retirement Income Security Act of 1974 (ERISA) provides that a claimant may internally appeal the claims administrator’s first denial of long term disability benefits within 180 days from the notice of benefit denial. The plan administrator may allow for a shorter period to file a second or third appeal of the benefit denial. Most group policies allow for at least two internal appeals, and usually for three appeals, with the third appeal sometimes being optional to the claimant. lawyers use this initial 180 day period to gather and organize medical records, arrange for a medical examination of our client, have our client undergo a functional capacity assessment, and retain an expert to perform a vocational analysis regarding our client’s background, training, and education as it relates to his or her performance of occupations.

ltd-claim-processERISA provides that a long term disability plan administrator shall notify a claimant of the plan’s benefit determination on review within a reasonable period of time, but not later than 45 days after receipt of the claimant’s request for review by the plan. If the plan administrator determines than an extension of time for processing is required, written notice of the extension shall be furnished to the claimant prior to the termination of the initial 45-day period. In no event shall the total period of review exceed 90 days.

As a pre-requisite to filing suit an ERISA plaintiff must exhaust his or her internal administrative remedies. The disability benefit experts at meticulously present all of your evidence of disability during the administrative appeal process in order to establish a proper record for the court’s review, should your claim be denied by the carrier.

The deadline for filing suit under ERISA for denial of long term disability benefits is established by your state’s statute of limitations for contract claims, (usually a period of 2-6 years). However, in some cases the court will allow the long term disability plan administrator to establish a shorter limitation period for filing suit. That’s why it’s important to have an attorney of review your policy to determine the actual limitation on filing suit within your particular jurisdiction.

The suit for recovery of long-term disability benefits usually involves the court’s review of all records in the administrative record that were created by the claimant and the insurance carrier. The lawyers of will have an opportunity during the suit to file legal briefs arguing the basis for your benefit eligibility based on evidence of disability. It may take approximately one year from the date suit is filed for the court to render a decision. The losing party has at least one available appeal.

To discuss the particular logistics of appealing your disability benefits denial, contact the attorneys at