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You’ve filed your long-term disability (LTD) appeal. You followed the instructions, submitted medical records, maybe even worked with your doctor or an attorney. Now comes the hardest part: waiting.
You may be checking the mail or your inbox daily, wondering when the insurance company will respond. If it’s been several weeks—or even months—you’re not alone in wondering: Why is it taking so long to get a decision?
In this article, we’ll explain why delays happen, what might be going on behind the scenes, and how to tell the difference between a normal delay and a red flag.
The Official Timeline (and What It Really Means)
Under federal law (ERISA), insurance companies must follow specific timelines when reviewing a disability appeal:
- They have 45 days to make a decision after receiving your appeal.
- If they need more time, they can get a 45-day extension—but only if they notify you in writing and give a valid reason.
This gives them a total of up to 90 days to decide your appeal.
But ERISA also allows something called “tolling,” which means the clock can be stopped. For example, if the insurance company is waiting for additional medical records or a statement from your doctor, they don’t have to count that time against the 90-day limit—as long as they tell you.
If the insurance company is requesting new information, they should tell you how long you have to submit it. Once that information is received, the clock starts again. So while you might expect a decision in 6 to 12 weeks, real-world circumstances can extend that timeline.
What Happens While You’re Waiting
It may feel like your case has disappeared into a black hole, but there’s often a lot going on on the insurer’s end—some legitimate, some less so.
Multi-Level Review Process
Most insurance companies have a multi-tiered internal review process. Your appeal may be reviewed by:
- A nurse case manager
- An in-house medical director
- A vocational rehabilitation specialist
- A claims analyst or appeals committee
Each of these parties may have to weigh in before a final decision is made.
Independent Medical or Vocational Reviews
Insurers often send your records to outside doctors or vocational consultants to review your functional limitations. These “independent” reviewers are supposed to offer an unbiased opinion, but the process takes time—especially if additional clarification is needed from your providers.
Internal Delays and Backlogs
Like any large organization, insurance companies can experience staff shortages, holiday slowdowns, or simple administrative bottlenecks. These don’t excuse unreasonable delays, but they do contribute to slower decisions.
Does a Delay Mean Your Appeal Is in Trouble?
Not necessarily. In fact, a faster denial isn’t always better. A longer review period may mean that your file is being taken seriously and reviewed carefully.
Delays in the appeals process can be frustrating, especially when your financial security is at stake. But not all delays are a sign of bad news. In many cases, they’re just part of the system—and manageable with the right strategy.
However, excessive delays, poor communication, or failure to provide updates can be signs that something is wrong. If the insurance company isn’t meeting ERISA deadlines—or isn’t keeping you informed—you may need to take action.
What You Can Do While You Wait
The waiting period can feel helpless, but there are things you can do to stay proactive and protect your claim:
- Track Deadlines: Mark your appeal submission date and watch for the 45-day and 90-day review windows.
- Follow Up Appropriately: It’s okay to check in with your claims representative, especially if you haven’t heard anything after 45 days.
- Document Everything: Keep copies of all letters, emails, and phone call logs with the insurer.
- Stay Off Of Social Media: The insurer may be monitoring your online activity, and even innocent posts can be taken out of context.
- Keep Your Medical Providers Informed: Let your doctors know that the insurer may contact them. Ask them to prioritize returning any forms or letters.
When to Be Concerned
While delays aren’t always a cause for alarm, there are some red flags to watch for:
- You haven’t received any updates after 90 days.
- The insurer fails to explain why your appeal is still under review.
- You receive vague or repeated requests for documents you’ve already submitted.
In these cases, it may be time to speak with a disability lawyer. Even if you filed your appeal on your own, a legal professional can step in and make sure the insurer is following the law—and not abusing the process.
How a Disability Attorney Can Help
The appeals process is challenging enough without having to monitor deadlines, analyze medical reports, and respond to third-party reviewers on your own.
An experienced disability lawyer can:
- Track the insurer’s review deadlines and push back on unnecessary delays
- Ensure your file is complete and compelling
- Respond to independent medical reviews and other insurer tactics
- Prepare you for what comes next if the appeal is denied
If you’re still waiting for a decision and don’t know what’s going on, we’re here to help. Contact us today and let’s discuss your situation.
Get Help with Your Long-Term Disability Appeal
If your LTD claim has been wrongly denied or terminated and you’d like to speak with an experienced long-term disability insurance attorney, contact us. Nick Ortiz and the experienced legal team at the Ortiz Law Firm represent claimants throughout in the United States. Call (888) 321-8131 to schedule a free case evaluation today.
