The federal ERISA statutes govern disability income policies and mandate strict timelines for each aspect of the claim process. These regulations help ensure timely resolutions of claims.
After receiving a formal claim denial, the plan holder can appeal the insurer’s decision and request a full and fair review of their claim. But if you wish to appeal your claim, you must act quickly.
How long do I have to appeal a denial?
As with initial ERISA claim decision timeframes, the appeal process also has strict filing deadlines in place. If a claimant submits a request for an appeal after the deadline, the insurance company is not required to accept the appeal for review.
After receiving a denial notification, you must file a written appeal within 180 days. While this may initially seem like an excessive amount of time, this gives you adequate time to prepare a thorough appeal for even the most seemingly straightforward claim.
Typically, each claim has strengths and weaknesses. Given that your appeal documentation must include additional details regarding your case, it could benefit your claim to use the appeal timeframe to gather supplementary claim information. This could include:
- Securing your full medical records
- Obtaining additional medical support from either the original treating doctor or a new physician
- Getting any needed medical testing
What happens next?
Once your insurer receives your appeal letter and additional documentation, they must conduct a full review of your case. After completing the review, the insurance company must notify you of their final decision, which could be a denial, an approval or a partial approval, within 60 days.