I represent a 59 year old financial broker that Reliance found disabled under a group long term disability (“LTD”) policy today, which is governed by ERISA. The application was filed on September 16, 2015. Under ERISA, the insurer has 45 days to render a decision, which would have been October 31, 2015.
On November 2, 2015, when I notified Reliance about the deadline elapsing, Reliance claimed that the deadline had not passed because the unit making the decision said it did not receive the application until October 16, 2015. After I responded that I had a fax confirmation that Reliance received the application on September 16, 2015, Reliance advised me that it would make its decision that week. At week’s end, I was told the claim had been recommended for approval, which a manager had to accept. That acceptance came today.
I doubt that the decision would have been received by today if I had not raised the ERISA deadline, which can adversely affect the claim fiduciary. For example, in New York, if an appeal deadline is ignored, a claimant could deem the decision to be denied, which ultimately can lead to a more favorable standard of review being applied. Claims handlers usually have caseloads that are too heavy to manage properly, which results in delays. Claims handlers are also frequently told by managers to delay approvals as a means of manipulating reserves to meet financial goals. Letting a claim handler know that you are aware of the ERISA deadlines may help focus attention on your claim in order to receive a timely decision.Previous Next
DISCLAIMER This website provides general information on disability law topics as a public service. Information is intended to be as accurate and current as possible, but should not be relied on as legal advice. No attorney/client relationship is created by viewing or using the content on this website. Each legal problem is different, and past performance does not guarantee future results. You should not act on any of the information contained in this site without first consulting legal counsel, which is why readers are advised to seek experienced legal representation in connection with disability related issues. Our Internet links are not associated with us, and we do not guarantee the accuracy of, any information contained in any link. Past performance doesn’t guarantee future results.
Copyright © 2023, Law Offices of Jeffrey Delott
Site Powered By: WebDesignYou