The 10th Circuit Court of Appeals recently reaffirmed ERISA’s requirements that when your Long Term Disability benefits are denied or terminated, you must follow your plan’s rules for administrative remedies before you can bring suit against your LTD insurance company. ERISA requires LTD insurance carriers to provide you with the opportunity to appeal your claim administratively to the insurance company. ERISA also requires the company to notify you of this right to administratively appeal before you bring suit against the company.
Generally, the Summary Plan Description, i.e. the document that summarizes your policy for you, should contain the requirements for your right to appeal a denial or termination of disability benefits. However, as the Circuit Court explained in Holmes v. Colorado Coalition for the Homeless Long Term Disability Plan, so long as your plan allows the insurance company to advise you of your rights and requirements for an appeal, and the company does advise you, then you must follow these requirements before you may bring a lawsuit.
It is important to understand your rights and requirements under your Long Term Disability policy when filing a claim. Knowing when you can bring a lawsuit as a part of your claim for disability benefits is only one of the often complex steps in obtaining benefits. If your claim is intricate, it can be in your best interest to have an advocate in your corner helping you navigate the claims filing process.