When appealing a denial of long-term disability benefits, it
is important to act fast to develop the information to rebut the reasons the
insurer gave to deny the claim. The
relevant period for determining disability is the “elimination period,” which
is usually the 180 days after you become disabled. If you wait too long to do the testing you
need for your appeal, the insurer can disregarding the information on grounds
that while it may show that you are disabled at the time of the testing, it
does not show that you were disabled during the elimination period. This was demonstrated in the case of Kellyv. Reliance Std. Life Ins. Co., 2011 U.S. Dist. LEXIS 147133 (D.N.J. Dec.
21, 2011), where the court disregarded the claimant’s cardiac condition in
determining if he was disabled because he first received treatment for the
condition after the elimination period, even though the condition contributed
to his disability during the elimination period. The case illustrates why it is important to
talk to an attorney early in the appeal process so we can develop a
comprehensive and timely plan to maximize your chance to get disability
benefits. Other information on appealing
disability benefit denials under ERISA and for private plans is on the
Employment Law section of our website.
