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Posted on Tuesday, April 16th, 2024 at 1:41 am    

How Long Does a Disability Appeal Take_ image

Has an insurance company denied your claim for long term disability benefits in Philadelphia, Pennsylvania? You can submit an appeal if so.

How long does a disability appeal take? There’s no universal answer to this question. That said, the law typically requires insurance companies to make decisions about appeals within a reasonable timeframe.

The Process of Appealing a Disability Denial

The process to appeal disability denial can vary. Many insurance companies have administrative procedures for appealing their decisions. Check your policy to determine the exact steps you need to take.

While the process may vary from one insurer to another, there are certain steps it’s virtually always wise to take when you appeal for disability after a denial. They include:

  • Determining the reason for the denial – Make sure you thoroughly understand why the insurance company denied your claim. Knowing the reason for the denial is key to knowing what you may have to do to strengthen your argument.
  • Gathering more medical documentation – Confirm the insurance company had all the medical documentation it needed when reviewing your claim. You may be able to gather additional evidence the insurance company didn’t initially have. Depending on your condition, it might even be smart to undergo additional medical tests.

Be aware that laws and regulations can also dictate how an insurance company may design its process for appealing a denial. For example, if you receive disability insurance through an employer in the private sector, the Employee Retirement Income Security Act of 1974 (ERISA) applies to your benefits. The law establishes certain requirements and prohibitions for insurers, like prohibiting them from requiring you to pay a fee to appeal a denial.

How Long Do You Have to Appeal an LTD Denial in Pennsylvania?

The law also determines how much time you have to file an appeal. You have 180 days to appeal a denial for long term disability benefits. If you miss the deadline, the insurance company may not be required to review your appeal.

Missing the deadline is a mistake you want to avoid. However, that doesn’t mean you want to rush to file an appeal immediately after learning of a denial. Take advantage of the 180-day period to put together a comprehensive appeal with supporting evidence.

How Long Does an Appeal for Disability Take in Philadelphia, PA?

The law doesn’t allow insurers to take as long as they wish when reviewing long term disability claims and appeals. If ERISA governs your benefits, the insurance company has 45 days to render a decision.

In addition:

  • If it will take more than 45 days to make a decision, the plan administrator can extend the timeline by another 30 days. They must notify you before the end of the initial 45-day period when extending the timeline. The plan administrator must also explain when you should expect a decision.
  • Sometimes, it will take even more time to decide whether to approve a claim during the appeals process. The plan administrator can notify you of the need for a second 30-day extension period in these circumstances. They must also explain what issues may be preventing the insurance company from rendering a decision. If you can provide information to help the insurer decide on your claim, you should have at least 45 days to gather and provide the necessary information and documentation.

Filing a Lawsuit After an Appeal Denial

How Long Does a Disability Appeal Take_ image 2The insurance company may still deny your claim after you submit an appeal. You may decide to file a lawsuit and go to court if you think you deserve to receive benefits.

It’s essential to submit all medical evidence you believe is relevant when filing your initial claim or appeal. Although there are exceptions, jurisdictions usually won’t let you introduce new evidence when going to trial.

Contact a Philadelphia, Pennsylvania, Long Term Disability Lawyer

You can hire an attorney to represent you when appealing a long term disability denial. Strongly consider doing so.

First, it’s vital to remember that this overview only applies to the appeals process when ERISA governs your benefits. Depending on how you receive disability insurance, ERISA may not apply. For example, ERISA may not apply if you work for a government employer or a church.

A Philadelphia, Pennsylvania, long term disability lawyer at Capitan Law can answer any questions you may have about the specifics of your case. More importantly, we can help you gather evidence, determine the reason for a denial, and generally help you boost your odds of receiving benefits. Learn more by contacting us online today or calling us at (267) 419-7888.

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