There is no one-size-fits-all timeline when it comes to resolving your Long-Term Disability claim. Many factors will impact how long it takes for your case to resolve, including whether or not your initial claim is denied and an appeal is required. An attorney for long-term disability at Marc Whitehead & Associates can offer sound guidance and assistance at every stage of the process and help bring your claim to a favorable resolution in a timely manner.
Initial Stages of a Long-Term Disability Claim
Filing the claim
Start the claim submission process by reading your Long-Term Disability policy carefully. Fill out the required forms and answer all questions honestly. Focus on why you cannot work and be specific. For instance, if back pain is the cause of your disability, do not simply answer that the pain prevents you from working. Instead, for example, state that you are unable to sit for more than 30 minutes at a desk.
Next, you must gather and submit the required documents. Such documents include:
- Your medical records
- Doctor’s opinion
- Lab results
- Imaging test results
Review and evaluation
When insurance companies assess disability claims, they compare the applicant’s job duties with their level of disability. Medical and vocational experts are consulted to evaluate the applicant’s medical condition and their ability to work at their current job.
The complexity of the disability
The nature of the disability affects processing time, and the more complex your disability, the longer you can expect it to take. Some conditions require additional medical assessments, which also adds to the length of the timeline.
Insurance company procedures
Variations in processing times occur among insurance companies. Claims adjusters must review a great deal of information and evidence when determining whether to accept or deny a claim.
Remember, you provide much of that information. You want to make sure that you are not inadvertently giving the adjusters information that can harm your claim. That is another reason why you should seek legal guidance when going through the Long-Term Disability claim process. Your attorney can advise you on how to handle conversations with the adjuster.
Common Delays in Long-Term Disability Claims
Incorrect paperwork
Perhaps the most common–and avoidable–reason for a Long-Term Disability claim delay is filling out the paperwork incorrectly. Check and recheck all your forms before submission.
Request for additional information
Requests for additional information are among the most frequent reasons for delay in a Long-Term Disability claim. Without certain vital information, the claims adjuster cannot come to a decision. Besides medical records, additional information may involve financial statements and tax returns. That is especially true for individual policyholders, since their benefits are related to their monthly income. Those with group coverage will generally have their employer provide that information to the insurer.
When insurers need more details, how this impacts the timeline depends upon the nature of the request. Promptly responding to information requests is the best way to avoid delay and keep the claim moving forward.
Medical assessments and opinions
Delays are often caused due to the need for medical exams or specialist consultations. It is extremely important that you schedule and attend all medical appointments relating to your claim. Failure to do so seriously jeopardizes your claim.
Average Timelines for Different Stages of a Long-Term Disability Claim
Initial claim processing
On average, the typical duration from claim submission to the initial decision is 45 days. However, depending on the insurance company and other circumstances, that timeframe may extend to three or four months.
Factors affecting the speed of the initial decision include the type of policy. If your employer’s plan is subject to the Employee Retirement Income Security Act (ERISA), the federal government determines the timeline. Such plans are subject to the initial 45-day decision, with the possibility of two extensions of up to 30 days each. That means the maximum timeframe for the initial decision in an ERISA plan is roughly 105 days.
Keep in mind that an individual disability plan does not fall under ERISA. Insurers are supposed to come to an initial decision after a reasonable period of time, but there is no definition of what “reasonable” constitutes. Expect that the initial decision for an individual plan may take longer.
Appeals process
If your ERISA claim is denied, you have 180 days from the date of the denial letter to appeal your claim. The insurer should make a decision within 45 days of receiving your appeal. Insurers have the right to another 45 days if they need additional time to reach a decision. In a worst-case scenario, a decision should come within about nine months of your denial letter date.
In an ERISA appeal, your lawyer will make sure that you present all evidence supporting your disability claim. If the appeal is denied, you have the right to petition for a judicial review.
NOTE: At that point, you are not allowed to submit any additional information or records to your claim.
All of this does not hold true for individual policies not subject to ERISA. The appeals process for such policies is not as strict. Overall, the timeline is usually longer for a non-ERISA policy.
Legal representation
Navigating a long-term disability claim is complicated. An attorney can expedite the process by making sure all forms are filled out correctly, gathering all required paperwork, and may even partner with medical and vocational experts to help prove your claim.
Contact a Long-Term Disability Attorney
If you are having issues with your Long-Term Disability claim, contact the experienced disability benefits team at Marc Whitehead & Associates. Schedule a free, no-obligation consultation today.
