When your long term disability benefits terminated or were denied, there can be a few options. It depends on the type of policy or plan you have. If you receive disability coverage through your employer then you have an ERISA plan. The ERISA plan’s rules and regulations will likely apply. Under ERISA law, you are required to “exhaust” your administrative remedies prior to filing a lawsuit. You must follow the appeals process laid out in the insurance policy.
Most policies require you to file one mandatory appeal with the insurance company. Some policies may require you to submit two appeals before you can file a lawsuit. Additionally, some insurance policies require one mandatory appeal and allow an additional “voluntary” appeal. Once you exhaust the administrative remedies contained in the policy, then you will be able to file a lawsuit against the insurance company.
When your long term disability benefits terminated, the appeal process is critical. This is the only time you will be able to introduce new evidence supporting your disability. In other words, once a final denial is made, after all administrative remedies have been exhausted, the file is closed. You will no longer be able introduce new evidence in support of your claim for disability benefits.
If you purchased your own individual disability insurance policy then you may not have to file an appeal. The same is true if the policy was issued by a government or church employer. It would also apply if the policy was issued to an association of which you are a member. These sorts of policies either do not fall under ERISA law or are an exception.
Individuals not covered by ERISA are entitled to file a lawsuit against an insurance company at any point during the claims process. In cases where ERISA law does not apply, individuals are entitled to introduce new medical evidence following the denial an appeal.
These rules can be very complicated. Please contact our firm to speak with an experienced disability insurance attorney about what steps must be taken in order to protect your disability benefits.