When can you appeal a denial claim in New Jersey?

On Behalf of | Aug 7, 2021 | ERISA

When the short-term or long-term disability benefits you have been receiving are coming to an end, you can appeal to have your employer or insurance company keep giving you your benefits. Read on to find out what to do and when you can appeal a denial claim in New Jersey.

Why would insurance adjusters deny your claim?

There are stringent rules for applying or appealing long-term or short-term ERISA benefit claims. For example, you may need to keep giving medical reports of your condition to the insurance company to receive your benefits. If your doctor confirms that you are getting better and can go back to work, then the insurance company can deny you your claims.

Also, missing deadlines can lead to denial of your claims. If you are applying, appealing, or submitting any document, you must do so within the stipulated timeframes to avoid cancellations. Of course, you can often have this time extended with the help of an attorney.

When to appeal a denial claim

When the insurance company denies your ERISA claims, you only have 180 days from the date of denial to appeal your case. But, you should be aware that if you are filing for a lawsuit, this timeline could be shorter. Thus, it is advisable to work closely with your attorney to know exactly how to proceed with the given time.

The insurer also has a limited time to respond to your appeal on the denied claim. For example, if you need their approval before receiving your medical care, they must respond within 30 days of the appeal. And, if it’s a post-service claim, they need to respond within 60 days.

Moreover, if you are receiving ongoing treatment and your claims have come to an end, the insurer must notify you in advance about the termination or reduction so that you can have sufficient time to appeal. They should also give you a good reason as to why they are terminating or reducing your benefits.

Depending on your situation, you can have the court extend the time limit to appeal a denied claim. However, to be on the safe side, try to adhere to the timelines and gather all the evidence that you need to restore your benefits.