When a disability insurance company ignores your long-term disability (LTD) appeal, it can be both frustrating and legally problematic. The appeals process is designed to give claimants a fair chance to challenge a denial, and insurance companies are legally obligated to respond to these appeals in a timely manner under most LTD policies and federal law. Here’s what you need to know if your insurance company doesn’t respond to your appeal in a timely manner.
1. Understand the Timeline Requirements
Most LTD policies have specific time limits within which an insurer must respond to an appeal. Under ERISA (the Employee Retirement Income Security Act), which governs most employer-sponsored disability plans, insurance companies generally have 45 days to review and respond to an appeal. They can extend this time for another 45 days, but they must notify you in writing, explain why they need more time, and specify what additional information (if any) they need.
If your policy is not governed by ERISA (such as an individual LTD policy you purchased outside of work), there may still be state-regulated time limits that the insurance company must follow.
2. Possible Reasons for a Delayed Decision
Insurance companies may delay making a decision on an appeal for a number of reasons, including:
- Backlog of Claims: Insurers sometimes have too many claims to process in a timely manner.
- Request for Additional Information: They may claim they need more medical records or supporting documentation.
- Internal Review Delays: Sometimes the delay is due to a lengthy internal review or a lack of resources.
While delays do happen, it’s not acceptable for your appeal to be ignored or delayed indefinitely.
3. What to Do If Your Appeal is Ignored
If you’ve waited beyond the stated response time without a decision or a valid request for an extension of time to decide, you can take the following steps:
- Follow Up in Writing: Send a written request for an update, including the date you submitted your appeal and noting that the response is overdue. This serves as proof that you’ve made an effort to communicate with the insurance company.
- Request Documentation: Ask for a copy of your claim file to see if there are any notes or documents that might explain the delay.
- Consult Your Plan’s Policy: Look at the terms of your LTD policy to confirm the insurer’s timeline obligations. If it’s governed by ERISA, make a note of the deadlines they must meet.
4. Legal Consequences of Failure to Respond by the Deadline
If an insurance company ignores or unreasonably delays responding to a valid appeal, it may be a violation of ERISA or the contract outlined in your policy.
If it is an individual claim, or otherwise a ‘non-ERISA’ claim, a delay may constitute “bad faith” handling, which can provide additional leverage in a lawsuit.
In an ERISA-governed policy, failure to meet response deadlines may allow you to proceed in federal court. While ERISA cases are complex and may require an attorney, this step can apply legal pressure and may encourage the insurer to respond to avoid litigation. If litigation is unavoidable, the court may rule in your favor. That’s happened in past cases:
In King v. Reliance Standard Life Insurance Company, the insurer failed to issue a timely decision or request an extension within the 45-day period for reviewing Megan King’s appeal of the termination of her long-term disability benefits. This failure allowed King to consider her claim “exhausted” and file suit. Reliance Standard later attempted to introduce evidence gathered after the exhaustion date, but the court excluded it, emphasizing that allowing such evidence would undermine ERISA deadlines designed to protect claimants.
In Tash v. Metropolitan Life Insurance Company, the insurer repeatedly missed deadlines, refused to issue timely denial letters, and failed to provide specific reasons for terminating benefits. Dr. Tash initially received long-term disability benefits, which were abruptly terminated without explanation. After a lawsuit and a settlement agreement with strict deadlines, MetLife again failed to meet the required deadlines and delayed decisions on Tash’s eligibility under the “any occupation” provision for nearly two years. The court ruled that MetLife’s actions undermined the ERISA process and required the insurer to pay past-due benefits with interest and bring Tash’s benefits current.
These cases highlight the importance of holding insurers accountable when they fail to follow claims procedures and deadlines.
5. How a Lawyer Can Help
If your insurer has missed its deadline, consulting a disability attorney can be crucial. They can contact the insurance company on your behalf, document all communications, and file a lawsuit if necessary. An attorney can also review your claim to identify any areas the insurance company may be using to justify a delay.
If your insurer ignores your appeal or delays issuing a decision, don’t let their inaction discourage you. We can help with the long-term disability appeal process or file a lawsuit against your disability insurance company. We represent clients nationwide, so you can hire our firm even if we are not in the same state.
Contact us to speak with experienced disability attorney Nick Ortiz. He has been handling long-term disability claims for two decades (since 2005), has experience with every major insurance company, and has a proven track record of successfully resolving long-term disability benefit denials. You don’t pay any fees unless you get your benefits. Call (888) 321-8131 today to schedule a free case evaluation.