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DISABILITY TIP OF THE WEEK: How long do I have to appeal?

ERISA PLANS
Every disability insurance plan is different, but disability claims that are governed by the Employee Retirement Income Security Act (“ERISA”) must allow you an opportunity to appeal if your claim is denied. The letter denying your benefits must tell you how long you have to appeal. Usually you will have 180 days from the date of the denial letter to appeal. Once your plan administrator has received your appeal, it will have 45 days to render a decision. If necessary, your plan administrator can take an additional 45 days. If they take longer than 90 days, your attorney can advise you whether filing a lawsuit is advisable. In some instances, your insurance provider will pay you a lump sum “by exception” while they continue to review your claim beyond the 90 day deadline.Most plans have a provision that requires a second appeal before filing a lawsuit. The deadline to appeal varies, but is often another 180 days. Again, the plan administrator can take 45 to 90 days to render a decision.

INDIVIDUAL POLICIES
Every individual policy has different deadlines. The letter denying your claim should tell you how long you have to appeal. Your policy will also have a provision that explains the appeal process and any deadlines.

SOCIAL SECURITY
If your claim for Social Security Disability benefits is denied, you are allowed 60 days to file an appeal from the date of the denial, plus 5 days for mailing. If you miss the deadline, you will be required to start the process over from the beginning. At the initial application phase, as well as after you have filed a Request for Reconsideration, the Social Security Administration can take anywhere from 3 to 6 months to make a decision. If your claim is denied after your Request for Reconsideration you again have 60 days plus 5 days for mailing to appeal.

REMEMBER: Every plan is different, whether governed by ERISA or not, so be sure to request a copy from your insurance carrier or employer. Pay close attention to the deadlines stated, or you could lose your chance to appeal or file a lawsuit.

 

Copyright (c) 2008 by John V. Tucker and Tucker & Ludin, P.A. All rights reserved. Any content borrowed or referenced from another source is referenced by citation to the original source as noted in the text above.

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    Social security is cutting my amount they are giving me, but now they are tiring to determine if they are going to cut my SSI check all together.and now I can’t even pay my bills.they are saying that they have over paid me since September of 2016. To me that doesn’t sound right….. Please help!!! I am a paraplegic in a wheelchair and could really use your help.

    I am a paraplegic in a wheelchair. Social security has been cutting my check since September of this year. They say that they overpaid me since September of 2016. I don’t know but that doesn’t sound right to me. I could really use your help please

    I am sorry you are having to deal with that. You are certainly entitled to have Social Security explain why they are cutting your benefits, and I would suggest that you either call them and stay on the phone until someone (even a supervisor) gives you an explanation, or better yet if you can do it, go to the Social Security office. Unfortunately, we do not handle SSI and SSDI overpayment claims, so we would not be able to assist you with that, but your starting point is to understand why they are claiming an overpayment. You may be able to figure it out without having to pay an attorney, since their explanation of why they are claiming an overpayment usually contains enough detail to figure out what they are doing. You could also ask for help from your Congressman, and they do not charge to assist. Attorneys that handle those claims usually are going to charge you for their services, so I would try the free options first to see if you can get it resolved quickly. Good luck!

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