If your long term disability benefits have been denied or terminated, you may be feeling overwhelmed and unsure of what to do next. One of the most important things to understand is that you have a limited time to file an appeal. Whether your claim falls under ERISA (the federal law that governs most employer-sponsored disability plans) or is based on a private policy, the appeal process is often your last and best chance to secure the benefits you deserve without going to court.
If you鈥檙e navigating a claim denial, understanding your rights and how to protect them can make all the difference. Below we鈥檒l answer common questions about long term disability appeal deadlines and why it鈥檚 so important to make your appeal count.
If your long term disability benefits were denied and your claim falls under ERISA (the federal law that governs most employer-provided disability plans) you generally have 180 days from the date you receive the denial letter to file an administrative appeal.
This 180-day window is strict. Missing it can mean losing your right to challenge the denial, even in court. It鈥檚 not just a deadline; it鈥檚 a critical opportunity to present your case with all the necessary medical, vocational, and legal evidence to support your claim.
Because ERISA appeals are limited to the evidence you submit during this administrative process, it鈥檚 incredibly important to get it right the first time. That鈥檚 why many people choose to work with a long term disability attorney at this stage. A lawyer familiar with ERISA and long term disability can help ensure your appeal is comprehensive, timely, and tailored to what your insurance company鈥攁nd the courts鈥攏eed to see.
The 180-day deadline to appeal a denial under an ERISA long term disability plan begins on the date you receive the denial letter鈥攏ot the date it was written or mailed. ERISA regulations (29 C.F.R. 搂 2560.503-1(h)(3)(i)) say claimants must be given a 鈥渞easonable opportunity to appeal鈥� and specifically provide at least 180 days following receipt of a denial notice.
Most insurance companies assume you received the letter within a certain number of days after they sent it, often five calendar days. Courts have consistently treated the receipt date (often presumed to be a few days after mailing unless proven otherwise) as the trigger for the deadline. Some insurers will try to calculate from the date of the letter, but that鈥檚 not correct under the regulations.
Because there鈥檚 no room for error with ERISA deadlines, it鈥檚 smart to act as soon as you get the denial. Even if you're still gathering records or working with your doctors, it鈥檚 a good idea to speak with a long term disability attorney early. An attorney can help track your appeal deadline, request an extension if appropriate, and begin preparing a strong case well before time runs out.
To protect your right to appeal, it鈥檚 crucial to keep these practical tips in mind:
It鈥檚 always advised to contact a long term disability attorney as soon as you receive a denial. An attorney can help confirm your deadline, review your denial letter, and begin preparing a detailed and fully supported appeal that increases your chance of getting the denial overturned.
If you miss the 180-day deadline to appeal a long term disability denial under an ERISA-governed plan, the consequences can be severe. In most cases, you lose your right to appeal through your insurance company鈥攁nd even more critically, you may also lose your right to file a lawsuit in federal court.
Under ERISA, the administrative appeal is typically mandatory before you can sue your insurance company. If you don鈥檛 file that appeal within the 180-day window, courts often view it as a failure to 鈥渆xhaust administrative remedies,鈥� which can lead to your case being dismissed entirely, no matter how strong your medical evidence might be.
That said, there are some exceptions鈥攍imited, but worth exploring:
These are complex legal arguments that usually require an attorney experienced with ERISA litigation. If you鈥檙e unsure whether you missed the deadline or want to know if an exception might apply, it鈥檚 critical to speak with a long term disability attorney as soon as possible. An attorney can review your denial letter, examine the claim file, and help determine your rights moving forward.
Under ERISA, you generally cannot get an extension beyond the 180-day deadline to file your appeal. The deadline is set by federal regulations, and most insurance companies will strictly enforce it. Once the 180 days have passed, they are not obligated to accept late appeals, even if you have a valid reason like waiting on medical records or dealing with a serious health issue.
That said, some insurers may voluntarily accept a late appeal, especially if you reach out before the deadline passes and explain your situation. This is entirely at their discretion, as they are not required to grant extra time. If you try to submit an appeal after the deadline has expired, they can (and often do) refuse to consider it.
This is one reason why it鈥檚 so important to seek legal assistance as early as possible. A long term disability attorney can:
Even if you think you need more time, don鈥檛 wait. The safest approach is to begin building your appeal right away and aim to file well before the 180-day deadline. That way, you protect your rights and leave time to gather medical records, secure expert opinions, and create a detailed, well-supported appeal.
That said, there are a few rare exceptions. For example:
But in most standard ERISA long term disability claims, you will have exactly 180 calendar days to file your administrative appeal. No more, no less.
Because missing the deadline can be fatal to your claim, it鈥檚 wise to have an attorney review your denial letter and your policy. A long term disability attorney can confirm your appeal deadline, clarify whether ERISA applies, and help ensure your appeal is timely and thorough.
If your disability insurance policy was purchased privately (meaning you bought coverage directly from an insurance company, not through your employer), it鈥檚 likely not governed by ERISA. These are called private or individual disability insurance (鈥淚DI鈥�) policies, and they generally follow state contract law rather than federal ERISA rules.
That means the appeal process and deadlines are set by your specific policy, not federal regulations. Some private policies may allow or require an internal appeal, but others don鈥檛. There is no universal 180-day deadline like there is under ERISA.
Instead, you鈥檒l want to check the language of your policy or denial letter to find out:
One important advantage of a private policy is that you usually have more flexibility when it comes to presenting your case in court. Unlike ERISA claims where the court generally only looks at the records submitted during the appeal, lawsuits involving private disability policies may allow for broader discovery, live testimony, and a full trial.
That said, your insurance company still has the upper hand if you鈥檙e not prepared. If your claim is denied, it鈥檚 a good idea to speak with a long term disability attorney who has experience handling both ERISA and private disability policies. They can help interpret your policy, determine your deadlines, and guide you on the best path forward鈥攚hether that means appealing, negotiating, or filing a lawsuit.
Yes鈥攁nd if your long term disability claim is governed by ERISA, submitting new evidence during the appeal is not just allowed, it鈥檚 essential.
Under ERISA, the administrative appeal is your one and only opportunity to submit medical records, expert opinions, test results, witness statements, or any other documentation that supports your claim. Once your appeal is decided, the record is usually closed. If you later sue your insurance company, the court will only review what was included in the claim file at the time of the final decision.
That鈥檚 why it鈥檚 so important to take the appeal seriously and not treat it like a simple formality. A well-prepared appeal should:
Building this kind of record can be time-consuming and complicated, especially while you鈥檙e managing your health. A long term disability attorney can coordinate with your doctors, obtain key records, and craft a detailed appeal that gives you the strongest possible chance of success鈥攏ow and in court, if it comes to that.
If your claim has been denied, don鈥檛 wait until the last minute. The appeal process is your window to correct the record, strengthen your case, and preserve your rights.
Start by carefully reviewing the denial letter. Insurance companies are required to explain why your claim was denied and what information they believe is missing. Your job during the appeal is to fill in those gaps and correct any misstatements or omissions in the record.
A strong appeal often includes:
Simply telling your insurance company that it made a mistake won鈥檛 be enough. Under ERISA, the appeal is your final opportunity to submit new evidence. Once the appeal decision is made, you typically can鈥檛 add anything else to the record, even if you go to court.
This is why so many people choose to work with a long term disability attorney for their appeal. An attorney can help identify what evidence is missing, coordinate expert reports, and submit a comprehensive appeal that directly refutes your insurer鈥檚 rationale for denial.
Your appeal is your best鈥攁nd sometimes only鈥攃hance to reverse your insurer鈥檚 denial and secure the benefits you deserve. It鈥檚 worth doing thoroughly and strategically.
Once you submit your long term disability appeal under an ERISA-governed plan, your insurance company generally has 45 days to make a decision. They are allowed to extend this deadline by an additional 45 days, but only under specific conditions. To lawfully take this extension, your insurer must notify you in writing before the initial 45-day period expires and must clearly state the special circumstances that require more time, along with a date by which they expect to make a final determination.
This requirement is outlined in the ERISA claims procedure regulation at 29 C.F.R. 搂 2560.503-1(i)(1)(i). If your insurer fails to follow these procedures, their delay may be considered a violation of ERISA, and you may be entitled to treat the appeal as denied and pursue further legal action.
During this time, your insurer is required to conduct a 鈥渇ull and fair review鈥� of your appeal. That often includes:
If they ask for more information, the clock may pause briefly while they wait for your response, but they still must resolve your appeal within the overall 90-day window unless you agree to a longer extension.
If your appeal is successful, your benefits should resume relatively quickly. But if your appeal is denied, the decision will usually explain your remaining legal options鈥攊ncluding whether you can file a lawsuit.
Because your insurer鈥檚 appeal decision may be final under ERISA (and the record is generally closed after that), it鈥檚 vital to make the most of this stage. A long term disability attorney can help ensure your appeal includes all the evidence and arguments needed to give you the strongest possible shot at approval.
Yes, you can sue your insurance company if your appeal is denied鈥攂ut the process and your legal rights depend on what kind of disability insurance policy you have: an ERISA group policy or a privately-purchased individual policy.
If your long term disability coverage came through your employer, it鈥檚 likely governed by ERISA, the federal law that controls most group benefit plans. Under ERISA, you must complete your insurance company鈥檚 internal appeal process before you can file a lawsuit. This is known as 鈥渆xhausting administrative remedies,鈥� and if you skip it, the court will likely dismiss your case.
Once you鈥檝e completed the appeal process and received a final denial, you have the right to file a lawsuit in federal court. However, ERISA lawsuits are very different from typical litigation:
This is one of the biggest reasons to work with a long term disability attorney early in the process. If your appeal doesn鈥檛 fully document your disability, it could severely limit your chances in court later.
If you bought your policy directly from an insurance company (outside of your employment), it is likely not governed by ERISA, and your rights are governed by state contract law instead.
In most private policy cases:
These lawsuits are generally more flexible than ERISA cases, but they can still be complex. An ERISA lawyer can help you understand whether to appeal internally first or proceed directly to litigation鈥攁nd how to protect your rights under your specific policy.
While it鈥檚 important to act quickly after a denial, you should not rush into filing an appeal without fully preparing your case. In ERISA long term disability claims, the appeal is your only opportunity to submit new evidence before the record closes鈥攁nd once the appeal decision is issued, you typically can鈥檛 add any new documentation, even in court.
That鈥檚 why the best approach is usually to start working on your appeal immediately, but wait to submit it until it鈥檚 complete. You want to use your time wisely to gather the right documentation and build a strong, well-supported argument that directly addresses your insurer鈥檚 reasons for denying your claim.
This often includes:
Remember, you typically have 180 days from the date on your denial letter to submit your appeal. That gives you time鈥攂ut not unlimited time鈥攖o build your case properly. Waiting until the last minute can create unnecessary stress and increase the risk of missing important details or documents.
This is also where having an experienced long term disability attorney can make a significant difference. A lawyer can help you prioritize what evidence is needed, manage communications with your insurance company, and ensure your appeal is filed strategically and on time.
Bottom line: don鈥檛 delay getting started鈥攂ut don鈥檛 submit your appeal until it鈥檚 ready.
The appeal isn鈥檛 just a formality. It鈥檚 your one chance to submit new medical evidence, expert reports, and legal arguments to convince your insurance company to reverse its decision. If you don鈥檛 present everything during the appeal, you usually won鈥檛 be allowed to add anything later, even if you end up in federal court.
If your appeal is denied, the next step is typically litigation. And ERISA litigation can be challenging:
Once your case reaches that stage, even the most experienced long term disability attorney may be limited by what was (or wasn鈥檛) submitted during the appeal.
That鈥檚 why it鈥檚 so important to get the appeal right鈥攁nd why many people choose to work with an attorney early in the process. An experienced long term disability attorney can:
In short, the appeal is your best shot at getting your benefits reinstated without the stress and cost of litigation. Having an attorney guide you through the process can significantly improve your chances鈥攁nd give you peace of mind knowing the record has been fully developed if the case needs to go to court.
At Riemer Hess, we鈥檝e spent over 30 years helping professionals and executives navigate every stage of the long term disability claims process, from filing initial applications to handling appeals and litigating complex ERISA cases in federal court. Our firm has a strong track record of success in securing and reinstating benefits, particularly during the appeal stage, where building a comprehensive and strategic record is critical.
We understand how insurance companies operate, and we know how to craft appeals that not only respond to denials but anticipate how those claims will be viewed by a judge if litigation becomes necessary. Whether you鈥檙e just starting your claim or facing a difficult denial, our experienced team is here to guide you every step of the way.
If you鈥檙e looking to file a long term disability insurance claim, appeal a wrongful claim denial, or litigate your insurer, Riemer Hess can help. Contact us today at (212) 297-0700 or click the button below for a consultation on your disability case.