One appeal or two: how your plan's appeal structure works

The federal appeal-decision deadline for disability claims applies whether your plan offers one internal appeal or two. Here is what that structural choice does and does not change.

The regulation governing how long a plan has to decide your appeal is written to cover either structure a plan might use. 29 CFR 2560.503-1(i)(3)(i) states that disability appeals are governed by the same rule whether the plan provides for one or two appeals, with the disability-specific 45-day figure applying either way.

Some group LTD plans require only one level of internal appeal before you can sue. Others build in a mandatory second internal appeal, meaning a claimant must complete two separate rounds of plan review, each with its own 45-day decision deadline, extendable once by up to 45 more days for special circumstances, before the plan's internal process is considered exhausted.

Whether your plan uses one appeal or two is a plan-document question, not a regulatory default, and it matters practically: filing a lawsuit before completing every internal appeal your plan actually requires is a mistake that can get a case dismissed for failure to exhaust, separate from the narrow deemed-exhaustion exception, which turns on the plan failing to follow the claims procedures the federal regulation requires, not on the plan following its own procedures badly and not on your own timetable.

How to find out which structure applies to you

Your plan document, summary plan description, or the denial letter itself should state whether a second-level appeal is available or required. If a second appeal is offered but optional, read the plan language carefully. Some plans distinguish between a second appeal you may request and one you must complete before suing, and the wording of your specific plan controls that distinction, not a general assumption either way.

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