ERISA Deadlines – The Administrative Appeal & The Statute of Limitations

ERISA is full of deadlines and those deadlines come very quickly after the first denial of your benefit. You will often find you have somewhere between 30 and 180 days to appeal your claim after it is denied.

Then, if that final denial of your appeal is issued, you must worry about something called the statute of limitations. The statute of limitations is the deadline for filing suit, and if this deadline is missed, then your case will almost certainly be dismissed very early on in the process. This deadline can be very different based upon policy language, factual circumstances, and state law. Even if you figure out how long the statute of limitations is, you also have to worry about when the clock begins to tick. Sometimes, the period begins on the date you become disabled. In other cases, it might be the date your claim is denied or the date you were required to tell the insurance company about your claim.  Determining when that clock starts and stops ticking is no easy thing to calculate because ERISA has been subjected to a lot of different interpretations and ERISA doesn’t contain its own defined clock or statute of limitation.

Courts will look to state law if a statute of limitation is not specified in the contract. If the contract provides a limitations period, things can be particularly counterintuitive because some courts have found that the limitations period begins running on the date of the claim, regardless of whether the claim was being paid or not.

Thus, an insurer could pay a claim for a year and a half, deny the claim and take six months or more to render its final appeal decision. If a two-year period is set out in the policy, the insurance company could argue you might have only months to file suit. This may sound like a lot, but it takes time to get the ERISA claim file from the insurer, the plan documents from the employer, and to decide who the proper defendants are.