You opened the letter from your insurance company. Your long-term disability claim was denied. Your stomach dropped. Now what?
If your disability coverage came through your employer, federal law probably governs your claim. That law is called ERISA. It stands for the Employee Retirement Income Security Act. Most people in Philadelphia have never heard of it until they get a denial letter.
Here is the part that matters most right now. You have a deadline to appeal. Under ERISA, that deadline is usually 180 days from when you receive the denial. Miss it, and your claim is likely over. No appeal. No lawsuit. Nothing.
Why the 180-Day Deadline Matters
The 180-day rule comes directly from federal regulations. Under 29 CFR 2560.503-1, insurance companies must give you at least 180 days to submit your appeal after receiving notice that your claim was denied.
That might sound like a lot of time. Six months feels generous. But here is the problem. Most people who are filing disability claims are dealing with serious health conditions. They are exhausted. They are overwhelmed. Days turn into weeks. Weeks turn into months.
Insurance companies know this. They count on it. A denial that goes unchallenged is money saved. It costs them nothing to send that letter and wait.
If you miss the 180-day deadline, the insurance company does not have to accept your appeal. Courts have consistently ruled that late appeals can be dismissed. Your case ends before it really begins.
When Does the Clock Start?
The 180 days start when you receive the denial letter. Not when it was written. Not when it was mailed. When it actually arrives.
This matters. Mail from an insurance company in Hartford or Chicago can take several days to reach Philadelphia. If the letter is dated September 1 but you do not get it until September 6, your clock starts on September 6.
Pay attention to the exact wording in your denial letter. Many letters say something like this: “You may appeal this decision by sending a written request within 180 days after receipt of this letter.” That language gives you a small cushion.
But do not push it. Mark your calendar the day you receive the denial. Count forward 180 days. Then back up at least two weeks. That is your real deadline. Give yourself time to prepare a proper appeal.
What Happens During the Appeal
Under ERISA, you must appeal to the insurance company before you can file a lawsuit. This is called exhausting your administrative remedies. Skip this step and a judge will likely dismiss your case.
The appeal is not a formality. It is your chance to add evidence. Medical records. Doctors’ opinions. Functional capacity evaluations. Vocational assessments. Whatever supports your claim.
This is critical. In most ERISA cases, if your appeal is denied and you go to federal court, the judge only looks at what was in your file during the appeal. You cannot add new evidence later. What you submit during the appeal becomes your entire case.
This is why so many claims are won or lost at the appeal stage. A strong appeal with solid documentation can change everything. A weak appeal with nothing new will almost always fail.
ERISA Claims in Philadelphia and the Surrounding Area
If you work for an employer in Philadelphia, Camden County, or anywhere in the Delaware Valley, and your disability benefits were denied, your claim is likely governed by ERISA. This applies whether you work in Center City, University City, or out in the suburbs along the Main Line.
ERISA cases from this area are typically heard in the U.S. District Court for the Eastern District of Pennsylvania, located right here in Philadelphia near Independence Hall. Across the river, New Jersey ERISA cases often end up in the District of New Jersey in Camden.
The local connection matters. Working with an attorney who understands these courts and how ERISA claims move through them can make a real difference.
What If You Already Missed the Deadline?
Missing the 180-day deadline is serious. But it may not be the end. Courts have allowed late appeals in rare situations. These include cases where the insurance company gave misleading information or where a medical emergency prevented timely filing.
This is called equitable tolling. It is not common. It requires strong evidence. But it exists.
If you are past the deadline, do not assume your case is over. Talk to an attorney who handles ERISA cases. There may be options you are not aware of.
Frequently Asked Questions About ERISA Disability Appeals
What happens if I miss the 180-day ERISA appeal deadline?
If you miss the 180-day deadline, the insurance company is not required to accept your appeal. In most cases, this means your claim is closed permanently. You also lose the right to file a lawsuit in federal court. Courts have consistently held that claimants must exhaust their administrative remedies before pursuing litigation. A missed deadline typically means that opportunity is gone. However, in very limited circumstances involving misleading conduct by the insurer or documented emergencies, courts have granted extensions. These exceptions are rare and require strong supporting evidence.
Does the 180-day deadline start from when the denial letter was sent or when I received it?
The deadline starts from when you actually receive the denial letter, not when it was dated or mailed. Most denial letters include language like “within 180 days of receipt of this notice.” Because standard mail can take several days, you may have a few extra days beyond what the letter date suggests. Still, you should not rely on this cushion. Document when you received the letter and start preparing your appeal immediately.
Can I add new evidence during my ERISA disability appeal?
Yes, and you should. The administrative appeal is typically your last opportunity to add evidence to your claim file. Under ERISA regulations, you have the right to submit written comments, documents, records, and other information supporting your claim. This can include updated medical records, specialist evaluations, functional capacity assessments, or letters from treating physicians. Whatever you submit during the appeal becomes part of the administrative record. If your case later goes to federal court, the judge will usually only consider what is already in that record. New evidence is generally not allowed at the litigation stage.
How long does the insurance company have to decide my appeal?
Once you submit your appeal, the insurance company generally has 45 days to make a decision on disability claims. If special circumstances require more time, they can take one additional 45-day extension. That means you could wait up to 90 days for a decision. During this time, continue to document your condition and stay in touch with your treating physicians.
We Can Help You Through This
Dealing with a denied disability claim is exhausting. You are already managing a health condition that has changed your life. The last thing you need is a fight with an insurance company.
But that fight matters. Those benefits exist for a reason. You paid into that policy. You deserve a fair review.
If you have received a denial and you are not sure what to do next, we are here to talk. There is no pressure. No obligation. Just a conversation about your situation and what options might be available.
Call 1-800-CANT-WORK. Visit 1800cantwork.com. Or send an email to contact@ericshore.com.
My team and I have helped people throughout Philadelphia, South Jersey, and the surrounding areas navigate ERISA claims. We understand how these cases work. We know what insurance companies look for. And we know how to build a strong appeal.
You focus on your health. Let us handle the rest.
