The U.S. Department of Labor explains how the Employee Retirement Income Security Act of 1974 governs disability benefits for most Florida workers with employer-sponsored benefit plans.
Our firm has helped clients deal with the red tape of filing and appealing disability claims under ERISA.
The plan must process your claim within a specified time frame
Your employer’s plan must process your disability claim within a reasonable period of time. This generally means that your plan administrator must approve or deny your claim within 45 days after receipt of your paperwork. However, the plan may extend this 45-day period if the administrator needs additional time to complete the review or seeks supplemental information from you. The administrator may extend this period even further to allow more time to evaluate your claim.
You may appeal a denial
If your plan denies your claim, the administrator must provide you with written or electronic notice explaining the basis for the rejection. This notice must state the specific grounds for denial and advise you of your right to appeal. You may have one or two levels of appeal, and the specific time frame for appeal may differ among plans.
Unless your plan allows an extension, you must file your appeal within 180 days after denial. Your administrator has up to 45 days to review your appeal, subject to a possible extension for an additional 45-day period. After you have exhausted your appeals, you may have the right to contest the denial in court.
The multilayered deadlines of the disability claims and appeals process can be confusing and may vary depending on your unique circumstances. Our website has information about contesting unfavorable decisions under ERISA.