Some people get approved within weeks after their initial appeal; others take many more months or even years longer than the average.
The following timeline is based on our years of experience in handling dozens of Short Term and Long Term Disability claims. It can be a very helpful tool for anyone going through the disability claims process.
Once you have applied, the entire process can take up to two years or even longer. Here’s how the disability insurance application and/or appeal process works:
Once you’ve submitted your initial application with all of the appropriate paperwork, the insurance company will contact your doctors, request your medical records and get additional information about your medical abilities. It typically takes 2-4 months for the insurance company to process your initial claim and issue a decision.
You then have 180 days to appeal a denial or cessation of benefits.
An attorney can “speed up” an LTD claim only with respect to how quickly he (or she) can put together a good and effective appeal package. It does not do a client any favors to use up the entire 180 day appeal period before filing the appeal.
We know time is of the essence for our clients. They are not working and they are not receiving their benefits. That is why we try to file the appeal as quickly as possible. Many of our appeals are filed approximately 45 to 60 days after we are hired.
Appeal Process (First Appeal)
The initial appeal process takes on average another 5 to 9 months.
If a claim is denied, the first thing we do is request the insurance claim file from the insurance company. The insurance company has 30 days to provide us the claim file. We then review the entire claim file (which can be as small as 100 pages or as large as thousands of pages) to determine the appropriate burden of proof and to index the medical records in the file. This typically takes 2-3 weeks.
We then update the medical records. Depending on the number of medical providers (hospitals/clinics/doctors/etc.), this process typically takes 60 days. During this time, we also work to obtain opinion evidence, such as assessment forms, from your treating doctors. We then file the formal appeal.
So, from the date we are hired, the appeal may not be finalized and appealed for approximately 2 to 5 months, while we obtain the claim file, index the claim file, update the medical records, develop new evidence, obtain statements from multiple doctors, respond to negative evidence in the claim file, and write an appeal letter full of legal citations.
The insurance company then has up to 90 days to respond. Approximately 50% of all claims are approved at this point, and 50% (or so) are denied.
Second Appeal (If Available)
Most disability insurance policies (though not all) allow a second appeal. The process and therefore the timeline for a second appeal is similar to the first appeal.
If you “exhaust” your administrative appeals with the insurance company, your next step is to file a lawsuit against the insurance company. Most Short-Term and Long-Term Disability claims go to Federal Court. The court process can take one to two years.
Mr. Ortiz is familiar with ERISA policies and procedures. He has helped numerous disability claimants nationwide obtain the LTD benefits they rightfully deserve. The Ortiz Law Firm can help you with your LTD appeal or lawsuit, whether your LTD policy is part of a group Long Term Disability Plan or an Individual Disability Income policy. Contact The Ortiz Law Firm right away at (866) 853-4512 to get a better understanding of your legal rights.