With the large number of Cigna claims we see in our practice, I am often asked, “How long does Cigna have to decide my long term disability insurance claim?” A common tactic used by Cigna is delaying its decision as long as it can. Most Cigna policies are issued to groups which are covered by ERISA, the federal employee benefits law. Despite the fact that the U.S. Department of Labor regulations state very clear time deadlines for ERISA disability claim decisions, Cigna repeatedly ignores its deadlines.
In the last several months, we have seen Cigna adjusters increase the use of what we call “serial requests for information.” Cigna claim adjusters send repeated letters asking for small amounts of information over several weeks just before their deadlines expire. This is actually an attempt to game the system, because the claim regulations allow them to stop the clock waiting for you to send them information back in response to their requests. The problem is that the information is rarely crucial, and it is almost always information they should have known was needed shortly after they received a claim for disability benefits.
So, if you have a Cigna disability insurance claim, this article explains how long Cigna may take to decide your claim or your claim appeal.
INITIAL DISABILITY CLAIM DEADLINES:
The basic time frame to decide your initial claim is 45 days, but the regulations allow for extensions, and Cigna can take up to 105 days to decide your long term disability claim. Here is the law that Cigna must follow to decide your group/ERISA disability insurance claim:
Initial 45 day period: The first deadline Cigna has to decide your long term disability insurance claim is 45 days after the plan has received the claim.
First 30 Day Extension: If something happens beyond Cigna’s control, the law allows them to ask for more time. In that case, an ERISA disability plan administrator like Cigna may ask for an extension of up to 30 days beyond the original 45 to issue a decision on your long term disability claim, i.e. 75 total days.
- IMPORTANT POINT ABOUT ANY EXTENSION: Cigna must tell you before the end of the first 45-day period that additional time is needed, explaining why circumstances require it, any unresolved issues and additional information needed, and when the plan expects to render a final decision. Cigna cannot wait until after the deadline to ask for the extension without violating the regulations.
Second 30 Day Extension: Cigna may also ask for another 30 day extension if something comes up beyond its control. Again, Cigna must advise you it needs the extension and why it is needed before the original 30 day extension expires. For any additional extensions, Cigna needs agreement from you.
Important Note About Requests for Information to You: If Cigna asks you for information, the deadlines in the regulations are suspended. Consider it like a time out….the clock stops. You need to get a response to Cigna with the information requested as soon as possible (assuming it was information Cigna was allowed to get from you in the first place). Once Cigna receives a response, the time starts running again.
Total Time Permitted for Initial Claim: 105 days, counting all extensions.
DISABILITY CLAIM APPEALS:
If your claim is denied, you have 180 days to file an appeal. (For some older claims that started before 2002, you will only have 60 days.) Once Cigna receives your appeal, the clock starts running for them to make an appeal decision on your LTD claim appeal.
Initial 45 day period: Cigna has 45 days to decide your long term disability insurance claim appeal. It can ask for an extension.
One 45 day extension permitted: If Cigna advised you of the need for an extension and the circumstances why it was needed within the original 45 day period, it may take an additional 45 days to decide the claim appeal.
Total Time Permitted for Appeal: 90 days, counting all extensions.
If Cigna does not decide your claim within the original 105 day period or your claim appeal within the 90 day time period, read my article on What Can I Do If Cigna Takes Too Long To Decide My ERISA Long Term Disability Claim?
For nearly 25 years, John Tucker has handled Cigna Long Term Disability Insurance claims. He frequently lectures on disability and ERISA topics. If you are looking for an attorney to handle your Cigna disability insurance claim or appeal, contact Cigna Disability Insurance Attorney John V. Tucker online or call (866) 233-5044. Your rights will change if Cigna has already denied your disability claim or if you have appealed, and talking to a disability benefits attorney who has the experience to handle your claim is important.