Calendar the dates and deadlines contained in the summary
plan description.
Dates and deadlines relating to long term disability denials and long term disability
terminations for things such as the submission of medical information or in an ERISA
plan, requesting an “administrative appeal” should be strictly observed, as a failure to
submit a timely notice of appeal will in all likelihood result in totally losing your ability to
file a lawsuit and seek compensation or legal recourse. If you are having trouble
meeting another kind of deadline, make sure you write the company a letter explaining
the circumstances and make clear that the “record” is incomplete without such
information. A decision should not be made without a complete record.
Remember, the insurer has to be “reasonable” in its methods when administering long term
disability benefits.
Generally, you will not get complete information concerning your medical
condition from existing medical records and reports. Your care and
treatment is probably ongoing. Certain tests have not been performed or
may not be available. Your condition may deteriorate or change. The
disability often involves a combination of impairments. You may
soon realize there is a psychiatric component to your incapacity.
Everyone faced with a life-changing illness or injury also faces challenging
psychological issues. The effects or side effects of certain medications are
not well documented. Other details, important for a full and fair
determination of your claim, require documentation. The insurer may want

to rush the process. For financial reasons, you may want a speedy
decision. Slow down! Unless your case is exceedingly clear, it is in your
best interest to keep the “administrative record” open until the insurer
receives all important information.

It is also essential to keep track of dates and deadlines because in many
jurisdictions the insurer or plan administrator has the ability to shorten
certain state law statutes of limitation. 11 Generally and historically a
consumer will have as many as six years within which to bring a “cause of
action” or “lawsuit” based on a contract dispute, into court. Most disability
policies, however, contain language shortening this period to one or two
years. Certain policies not only shorten the limitations period but also state
that the time “begins to run” when “proof of loss” is required to be
submitted, rather than when a “breach of contract” occurs, which is the
time-honored common law trigger for commencement of the counting. Such
limitations on the time within which you must bring a matter to court must
be observed in states which allow an insurer to modify by contract certain
statutes of limitation. As always, when dealing with insurers like UNUM, you
should not rely on articles like this one as specific legal advice for your claim.
You should consult an attorney who understands ERISA claims litigation and
how to handle long term disability benefits claims and long term disability
denials.

The ERISA law does not provide a limitation period within which a claim for benefits must be brought, therefore,
the courts look to comparable state law statutes, notably the typical six year period within which to bring a breach
of contract claim. Many states laws however, also allow contracting parties including parties to insurance contracts
to “agree” on shorter periods of limitation. Such “agreements” invariably appear in disability insurance policies. It
follows that if state insurance law prohibits unreasonably short periods of limitation, such laws would be “saved”
from preemption. For example see, M.G.L. c.175 §22 which prohibits limiting the time for commencement of
actions in insurance policies to a period of less than two years from the time when the cause of action accrues.