Legal Question in Disability Law in Georgia

Transitioning from short to long term disability

I was initially on short term disability for six months and was required by my Aetna healthcare provider to submitted the necessary paperwork so that they can make a decision on weather to grant my long term disability (over 6 mos.) claim. I gave them everything they had asked for, and then some, so that they can have all the necessary facts to approve my claim. After about 3 weeks of them having everything they needed, I got a letter from them saying they were going to extend their decision another 45 days and would let me know. I have not recieved a dime of pay in the last 4 months and now it is causing severe financial turmoil (my credit rating is being affected) and unnecessary emotional anguish to me and my family. Aetna won't allow me to talk to any decision makers about my situation and they won't tell me what it is exactly they are looking for in addition to what I and my doctors had provided them. My question is, how long can they keep playing this game of ''wait and see'' regarding my claim before communicating their decision to me?


Asked on 3/22/04, 2:23 pm

1 Answer from Attorneys
Wayne Wisong Wayne Wisong, Attorney at Law

Re: Transitioning from short to long term disability

Your question is not truly one of disability discrimination law. Nor is it really a question of Georgia law. Your problem is governed by a federal law called ERISA (Employee Retirement Income Security Act of 1974). Under that law, the plan administrator normally has up to 90 days to consider the claim. They can extend that for up to another 90 days for "special circumstances". If they deny the claim, you have 60 days to file a "request for review" (basically an administrative appeal), and they have 60 days to issue a final determination (120 for "special circumstances"). You do not have standing to sue until all that has elapsed. If this is an insured versus an administrative services only arrangement, state insuance law might shorten these periods. Also, the period specified in the plan or policy would apply if shorter. Just too many unknowns. If you want a free consultation on this, call me at (770) 534-1057.

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Answered on 3/22/04, 6:54 pm


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