Short answer: Under ERISA the plan must decide a disability claim within 45 days, extendable by up to two 30-day periods for reasons beyond its control. The claimant gets at least 180 days to appeal a denial, and the appeal must be decided within 45 days, extendable once by up to 45 days.
The DOL claims rule, 29 CFR 2560.503-1, sets these times for disability claims:
- Initial decision: no later than 45 days after the plan receives the claim, extendable by up to 30 days and then up to another 30 days, each time with notice explaining why (paragraph (f)(3)).
- Appeal window: at least 180 days after the claimant receives the denial (paragraphs (h)(3)(i) and (h)(4)).
- Appeal decision: within 45 days, with one extension of up to 45 days for special circumstances (paragraph (i)(3)).
Disability claimants get extra protections. They must receive any new evidence or rationale, free of charge, before a final denial on appeal. A retroactive cancellation of disability coverage counts as a denial that can be appealed. If the plan does not follow the rules, the claimant may be treated as having exhausted the appeal and can go to court.
Because a court usually reviews only the record built during the appeal, help the employee file a complete appeal with full medical records.