For Administrators and Employees
For a disability claim, the plan administrator must notify the claimant of the plan’s adverse benefit determination within a reasonable period of time, but not later than 45 days after receipt of the claim by the plan. The plan administrator may extend the period of time for which to make a determination up to 30 days as long as the extension is necessary and notified the claim of the reason for extension and the date by which a decision may be expected before the end of the initial 45 days.
A plan administrator may receive a second extension as long as the extension is necessary and notifies the claimant of the reason for extension and the date by which a decision may be expected before the end of the initial 30 day extension. Notices of extension must explain the standards for which entitlement to a benefit is based, the unresolved issues that prevent a decision on the claim, and the additional information needed to resolve those issues.
For more information regarding Benefit Claims Procedure visit the following Department of Labor page.