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Disability insurance denied: appeal deadlines and the lawsuit trap

Disability denials have a feature health denials mostly do not: the plan itself may set a deadline for filing a lawsuit, and courts can enforce it. Read this early.

If your disability coverage is through an employer

• Appeal window: at least 180 days after you receive the denial (your plan may give more). Late appeals can be rejected.
• Decision times: initial claims 45 days (with extensions up to 30 days at a time under set rules); appeals 45 days, plus up to 45 more if the plan notifies you of special circumstances.
• Your file: the plan must give you, free of charge and on request, relevant documents and the identity of any medical or vocational expert whose advice it obtained. Request the file.
• New evidence: include everything you want considered before the final decision.

The time limit for suing

After the plan's final denial you may sue, but the plan documents can set a limit for how long you have, sometimes counted from the "proof of loss" date rather than from the denial. The U.S. Supreme Court has held that such a plan limitation period can be enforced if it is reasonable (Heimeshoff v. Hartford, 2013). Find the clause in your plan and write down the date today. A lawyer who handles disability benefit cases can explain your options.

Individual policies and other benefits

Disability insurance you bought yourself follows state insurance law and the policy's terms; a state insurance department complaint may be available. Social Security disability is a different federal process, not covered here.

Disability appeal letter, claim file request.

Related guides

• ERISA vs state-regulated health plans: why it matters
• How to file a health insurance internal appeal
• Mental health or substance use care denied: parity and appeals
• State insurance department directory