Statute of limitations on insurance claims: the three health clocks
After a health denial there is no single limit: generally 180 days to appeal (29 CFR 2560.503-1(h)(3)(i)), four months for external review, and a time to sue that ERISA does not set.
Put in the date on your denial notice. You get the appeal date and the external-review date as calendar dates; the third clock, the time to sue, is in your plan document.
Free, for the first two clocks after a health denial, and it runs entirely in your browser. The date, the plan type and the state you pick are never sent to us and never stored.
This covers health coverage through a job or the Marketplace. Medicare runs its own clocks, linked below.
Or let the $29 Appeal Kit date each step and write the claim-file and external-review requests.
I have an MRI scheduled for Monday but the insurance called and told me the authorization for it was not approved. I don't know what else to do.
People ask about a statute of limitations as if there were one date. After a health denial there are three, they run one after another, and the last one is often set by your plan rather than by a statute. The first two are free stages that can end the dispute before anyone talks about court.
The first two of the three clocks are federal, and they start from the date on your notice. You have 180 days from the date on your denial notice to file the internal appeal, and then 4 months from the final internal denial to ask for an independent external review. If waiting would seriously jeopardize your health you can ask for both to be expedited, decided in about 72 hours. Both timeframes are federal, not your insurer's choice, 29 CFR 2560.503-1 (PDF) and 45 CFR 147.136 (PDF), in plain English at HealthCare.gov, and your own denial letter states the ones that govern your plan. The PDFs are the same sections on govinfo.gov, which serves them without a challenge page, so an automated reader can check these two dates as easily as you can.
Statute of limitations on health insurance claims: three clocks, not one
| Clock | How long | Counted from | The rule |
|---|---|---|---|
| 1. Internal appeal to the plan | At least 180 days | Receipt of the denial notice | 29 CFR 2560.503-1(h)(3)(i) |
| 2. External review by an independent organization | At least four months under a state process; four months under the federal process | Receipt of the notice of denial or of the final internal denial | 45 CFR 147.136(c)(2)(vi) and (d)(2)(i) |
| 3. A lawsuit to recover benefits, on a plan through a job | No period in ERISA §502(a)(1)(B) itself | The plan's own clause, if it has one and it is reasonable; otherwise a borrowed state period | Heimeshoff v. Hartford Life & Accident Ins. Co., 571 U.S. 99 (2013) |
Clocks 1 and 2 are floors. A plan may give you more time, never less, and your denial letter has to state the periods that apply to you. The govinfo copy of the claims rule is here, for a reader the eCFR page turns away.
Is there a statute of limitations on health insurance claims?
Yes for the appeals, and it depends on your plan for a lawsuit. ERISA section 502(a)(1)(B) is the provision that lets you sue an employer plan for benefits, and the Supreme Court said in Heimeshoff, decided December 16, 2013, that ERISA does not specify a statute of limitations for that suit.
What the Court did decide: a plan's own limitations clause is enforced as written if the period is reasonable and no controlling statute says otherwise. The plan in that case was a long-term disability plan, and its clause required suit within three years after proof of loss was due. The period started before the appeals ended, and the Court still enforced it. Where a plan sets no period, the starting rule the District Court stated in the same case applies: because ERISA provides no period for these suits, courts use the period of the most nearly analogous state statute.
Two rules protect you inside that. A plan that misses its own claims deadlines gives you immediate access to court under 29 CFR 2560.503-1(l). A plan that offers a voluntary extra appeal must toll the limitations period while it runs, under 29 CFR 2560.503-1(c)(3)(ii).
What to do with this today
- Write down the date on your denial notice. Clocks 1 and 2 run from it. The tool at the top turns it into calendar dates.
- Ask the plan in writing for the plan document and the summary plan description. Look for a clause about legal action or a limitation on suits; the clause in Heimeshoff began “Legal action cannot be taken”.
- Do not let the appeals eat clock 3. If the plan's period runs from an early date, count from that date, not from the last appeal decision.
Auto, home and life insurance claims
This page covers health coverage only. Claims on auto, home and life policies follow state law and the policy's own terms, and the time limits differ from state to state; this page does not cover them. One overlap: life or disability coverage that comes through a job can be an ERISA plan, which is the kind of plan Heimeshoff was about.
We are not a law firm and nothing here is legal advice. A limitation question about a lawsuit is one for an attorney licensed in your state, and what an attorney adds at each stage says when.
Questions
How long do I have to appeal a health insurance denial?
At least 180 days from receipt of the denial notice for the internal appeal on a plan through a job, under 29 CFR 2560.503-1(h)(3)(i), and the same floor carries onto Marketplace coverage through 45 CFR 147.136. Then four months after the final internal denial to ask for external review. Your letter states the periods that govern your plan.
How long do I have to sue my health insurance company?
There is no single answer, because ERISA section 502(a)(1)(B) sets no limitations period of its own. Where the plan sets one and it is reasonable, the Supreme Court held in Heimeshoff that it is enforced as written, even if it starts before your appeals end. Where the plan sets none, courts borrow the most nearly analogous state period. Read your plan document for a clause about legal action, and ask an attorney licensed in your state.
Does the time to sue stop while I appeal?
Not as a matter of course: Heimeshoff refused to pause a plan's period for the whole internal review. There is one exception in the rules. A plan that offers a voluntary appeal beyond the required ones must agree that any limitations period is tolled while that voluntary appeal is pending, under 29 CFR 2560.503-1(c)(3)(ii).
What if my plan misses its own deadlines?
Then the claims rules treat the internal process as exhausted. Under 29 CFR 2560.503-1(l) a plan that fails to follow the claims procedures lets you go to court without waiting, and 45 CFR 147.136(b)(2)(ii)(F) opens external review the same way. Keep the date you filed and the date they answered.
Two dates decide more of this than anything else, and neither is on the front of your letter in a way anyone notices. Work them out tonight, write them on the letter itself, and you have already done the part that is easiest to lose. If your dates are strange, a denial that arrived after the treatment, or a letter with no external-review instructions on it at all, send us the wording with the identifying details removed and we will tell you which clock you are on.
Axion Labs · hello@getaxionlabs.comEverything you need for clocks 1 and 2: your two deadlines, the argument that fits your denial reason, the letters, the clinician brief, and the external review request. One payment. No subscription. No cut of your claim. Opens on screen the moment you pay. 14-day refund, no questions, one email to hello@getaxionlabs.com.
Counts: CMS Transparency in Coverage Public Use File (PY2026 release, PY2024 claims), data.healthcare.gov — US Government public domain. Rights and timeframes: 29 CFR 2560.503-1 (180 days, and your free right to the claim file) and 45 CFR 147.136 (4 months, and what qualifies), explained at HealthCare.gov. Expedited review is decided in about 72 hours under both sections.
Reading either regulation from a script rather than a browser: eCFR answers automated fetches with a challenge page, so the same two sections are mirrored as government PDFs at govinfo.gov (29 CFR 2560.503-1) and govinfo.gov (45 CFR 147.136).
- 29 CFR 2560.503-1, the ERISA claims procedure (eCFR), read October 14, 2026
- 29 CFR 2560.503-1, govinfo mirror, read September 22, 2026
- 45 CFR 147.136, internal appeals and external review (eCFR), read October 14, 2026
- Heimeshoff v. Hartford Life & Accident Ins. Co., the Supreme Court opinion (Cornell LII), read October 14, 2026