Insight into Long Term Disability Delays and How an Attorney Can Help
Not being able to earn an income can be scary. If you or a loved one are cannot work due to an injury or medical condition, you have likely filed, or will soon be filing, an application for long-term disability insurance benefits. It is essential to know that your employer’s disability insurance company has certain obligations when reviewing your long-term disability claim.
In addition to specific procedures that must be followed, the law that governs your long-term disability insurance claim may also place a specific time frame on when insurance companies must make a decision on long-term disability claims. However, depending on the type of policy you have, there may be situations that allow the insurance carrier to exceed the specified time frame. In some cases, there may not be a specific time frame.
How Long Does It Take to Get Approved for Long-Term Disability Benefits?
Once you have filed your application for long-term disability benefits the insurer will need time to evaluate your claim. The insurance company will try to determine if you are disabled and unable to work. They will sometimes even go as far as hiring a private investigator to follow you around to try to catch you doing something that you claim you cannot do!
Insurance companies have also been known to delay to avoid having to pay you. They may not return your phone calls promptly or somehow not receive your faxes or emails. There is a long list of ways insurance companies can work you over during the process of applying for long-term disability benefits.
Generally speaking, a disability insurance company has 45 days to decide once all necessary documentation is received from you and your employer. The insurance company may request an extension if they need more time to make a decision or to obtain additional evidence. These requests for extensions must be provided to you in writing.
However, it is important to note that there is not a strict deadline for the insurance company to issue a decision regarding your claim for disability insurance benefits so long as the insurer can show that they are waiting for additional information that is necessary to decide your claim.
Application Deadlines and Timelines
There are many factors that can influence the amount of time it will take to get approved for long-term disability benefits. Each policy sets the specific parameters required for the approval of long-term disability claims. One of the critical factors affecting the timing of long-term disability claims decisions will be the disability insurance policy language itself, and it is heavily dependent upon if ERISA covers your policy.
In general, the timeline for processing your claim depends on the type of long-term disability coverage you have:
• Individual Disability Insurance (IDI): If you have an IDI policy that you purchased on your own, then the insurer usually has a “reasonable” timeframe in which to review and make a decision on your claim. IDI policies are not governed by ERISA.
• ERISA Disability: If you have an ERISA disability plan provided by your employer, your insurer must follow strict timelines. This amounts to up to 45 days for the initial decision and two additional 30-day extensions if the insurance company thinks they need them, but they are required to provide you with a reason and tell you exactly what they need to make a decision
Each time the insurance carrier must reach out to the claimant for more information or to follow up on an issue adds a bit more time to the process. This means it could take 105 days (or longer) to receive your initial decision for an ERISA disability claim. For an IDI disability claim, it can take even longer. Other factors responsible for long-term disability claim delays include:
Your Policy’s Elimination Period
Almost all disability insurance policies have an elimination period. This is the period between when you become ill or injured and when you can start receiving your long-term disability benefits. During the elimination period, you must remain continuously disabled to be entitled to benefits. In no event will you ever be entitled to benefits before the policy’s elimination period ends.
Your Medical Conditions
The more medical conditions you have and the more specialists you see, the more medical records you will need to obtain for the insurance company. Obtaining these records could take weeks, maybe even months. Your long-term disability insurance company can also request a functional capacity examination (FCE) or additional lab work or imaging to evaluate your health issues. If your insurance company asks you do any of these, then you should contact a disability attorney immediately. These tests will not prove your medical condition, will not support your claim, and could even risk your entire claim.
Is There a Time Limit on Long-Term Disability Insurance Appeals?
If your original claim is denied, you will need to challenge the denial by filing an appeal. This will only lengthen the time before you are paid. Again, this will be based on the type of long-term disability plan you have.
If your claim was denied and you appealed the decision, the insurance company’s typical timeframe to make a decision is even shorter. Generally, a disability insurance company has 45 days to issue a decision once the appeal is received. The insurance company may request one 45-day extension if “special circumstances” require additional time. If an extension is requested, you must be notified in writing. Therefore, the maximum time an insurance company may take to decide on your long-term disability appeal is 90 days.
The Process for Challenging a Claim Denial
If you have an ERISA disability plan, you must file an appeal to challenge a claim denial. You have up to 180 days to file your appeal, and during that time you will need to collect medical evidence to support your case. If the insurer sent an appeal form with your denial letter you can fill out the form and submit it along with your medical records. It is also advised that you hire a disability lawyer to help with your appeal.
Once you appeal, the insurance company has 45 days to make a decision. They can also request an additional 45 days if they do not feel they can make a decision.
If you have an IDI policy you may not have to file an appeal at all. IDI policyholders have the right to proceed directly to filing a lawsuit. If your IDI claim was denied you should consult with an attorney to determine if you would benefit from filing an appeal.
Is No News Good News When It Comes to Waiting on a Disability Approval Letter from the Insurance Company?
Long-term disability delays are not new at all. Typically, it takes anywhere from 2-3 months to receive a decision after sending in your initial application for long-term disability. However, this 2-3 month estimate is a best-case scenario. There are a variety of factors that can delay your insurance company from approving your claim. Some of these things are under your control, but others are not.
While you are waiting to receive a decision you should continue to get medical treatment as recommended by your doctors. Continue to tell your doctor about how you cannot work due to your medical condition and how your symptoms limit your ability to function every day and tell your doctors about any side effects you may be experiencing as your medications.
Take all your medications as directed and follow your doctors’ orders to excruciating detail. Remember, you might have someone conducting surveillance (spying on) you to see if your health problems are as severe as you claim. And, of course, start considering which disability attorney you may want to work with if your claim is denied.
Contact an Attorney for Legal Advice
Unfortunately, the process is often daunting and lengthy, even when you do everything in your power to avoid a delay. You may not understand everything involved in the process. Fortunately, the attorneys and legal team here at Ortiz Law Firm are available to assist claimants in their fight against insurers.
Ortiz Law Firm is dedicated to helping people recover the disability benefits they deserve. We handle group Long Term Disability (LTD) claims, individual policy disability claims, ERISA disability claims, and Social Security Disability claims. Although we do not usually handle short-term disability claims, we may be able to help if you also have long-term disability coverage. Led by Board Certified Disability attorney Nick Ortiz, our team is ready to fight for you.
It would be best if you had an experienced team of attorneys and professional staff who understand the rules and know how to use those same rules to fight back and protect the rights of people who have filed disability claims. The national disability attorneys at Ortiz Law Firm can offer legal advice to help improve the chances that you will be approved if you’ve been wrongfully denied benefits. Contact us online or call (888) 321-8131 to schedule a free consultation.