Long-term disability (LTD) benefits can last anywhere from a few years to retirement age, depending on the specific terms of your policy. Understanding how long benefits might continue—and what might cause them to stop—is key to planning for your financial future. Here’s what you should know:
Policy Terms Determine Duration
Every LTD policy is different. Some offer benefits for a fixed number of years—such as two or five—while others continue payments until you reach age 65 or your Social Security Normal Retirement Age (SSNRA). The maximum duration of benefits will be outlined in your plan documents, so reviewing your specific policy is essential.
Understanding the “Own Occupation” vs. “Any Occupation” Standard
The length of your benefits can also depend on how your policy defines “disability.” Most plans use a two-step definition:
- For the first 24 months, you’re typically considered disabled if you’re unable to do your own job.
- After that, many policies switch to an “any occupation” standard. This means you must be unable to perform any job you’re reasonably suited for by education, training, or experience.
This change can significantly impact whether benefits continue beyond the two-year mark.
RELATED POST: Own Occupation vs. Any Occupation
Ongoing Reviews While You Receive Benefits
Even after your claim is approved and benefits begin, the insurance company will continue to monitor your case. These periodic reviews are designed to evaluate whether you still meet the policy’s definition of disability.
During this process, the insurer may:
- Request updated medical records
- Ask for attending physician statements
- Require claimant questionnaires or activity logs
- Conduct surveillance or hire vocational experts
- Schedule an independent medical exam (IME) or functional capacity evaluation (FCE)
These reviews can happen every few months or annually, depending on your condition and policy. It’s important to respond promptly and thoroughly to any requests to avoid delays or disruptions in your benefits.
RELATED POST: 10 Tips to Maintain Approval of Your Long-Term Disability Benefits
When Benefits May End Early
Even if your policy offers long-term coverage, benefits don’t always last the full term. Payments can stop if:
- Your condition improves and you no longer meet the policy’s definition of disability.
- You return to work, even part-time in some cases.
- You don’t comply with ongoing claim requirements, such as providing updated medical records.
- Your condition falls under a policy limitation. For example, some plans only cover mental health disorders or chronic pain for 24 months).
Being proactive with documentation and medical care can help protect your benefits during these reviews.
What to Do If You Receive a Long-Term Disability Claim Denial
If your claim was denied, there are steps you can take to challenge the decision and fight for the benefits you deserve.
- Start by Reviewing the Denial Letter The insurance company must explain the reason for the denial and inform you of your appeal rights. This letter is your roadmap for what needs to be addressed.
- Request Your Full Claim File This file contains all the documentation the insurer used to make its decision. Reviewing it can reveal what evidence might be missing or misinterpreted.
- Build Stronger Evidence Collect any medical records that weren’t included, get detailed statements from your doctors, and consider obtaining additional medical opinions to support your case.
- Submit a Timely Appeal Under most policies governed by ERISA, you have 180 days to file an appeal. Meeting this deadline is critical—missing it could prevent you from pursuing your claim further.
- Get Professional Guidance if Needed The appeals process can be complex, and the insurance companies have teams reviewing every claim. An experienced long-term disability attorney can help you navigate the process and avoid common mistakes.
A denial can be disappointing—but it’s not the end of the road.
Schedule a Free Case Evaluation
If you’re facing a claim denial, the Ortiz Law Firm can help you understand your rights and next steps. We work with clients nationwide and focus exclusively on disability claims. Call (888) 321-8131 or contact us online for a review of your situation.
