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 disability insurance company has certain obligations when reviewing your long term disability claim. They cannot drag their feet and delay your claim without reason.
In addition to certain procedures that must be followed, the law governing your long term disability insurance claim may also specify a time frame within which insurance companies must make a decision. However, depending on the type of policy you have, situations may allow the insurance carrier to exceed the specified time frame. In some cases, a specific time frame may not even exist. By reading this article, you will gain insight into long term disability delays and how an attorney can help if your insurance carrier is delaying your claim.
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 may even hire a private investigator to follow you around to try to catch you doing something you claim you cannot do.
Insurance companies have also been known to delay decisions to avoid paying you. They may not return your phone calls promptly or might claim not to have received your faxes or emails. There is a long list of ways insurance companies can make the process difficult for you.
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 isn’t a strict deadline for the insurance company to issue a decision about your disability insurance benefits claim as long as the insurer can demonstrate that they are waiting for necessary additional information.
Application Deadlines and Timelines
There are many factors that can influence the amount of time it takes to get approved for long term disability benefits. One critical factor affecting the timing will be the specific language in the disability insurance policy, and whether or not your policy is covered by ERISA.
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 within 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, the insurer must follow strict timelines. They have up to 45 days for the initial decision and may request two additional 30-day extensions if needed. However, they are required to provide you with a reason and specify what they need to make a decision.
Each time the insurance carrier reaches out to the claimant for more information or to follow up on an issue, it adds more time to the process. This could mean it may take 105 days (or longer) to receive your initial decision for an ERISA disability claim. For an IDI disability claim, the timeline could be even longer.
Other Factors Responsible for Delays
Your Policy’s Elimination Period: Almost all disability insurance policies have an elimination period. This is the time 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 qualify for benefits. Under no circumstances will you 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. Obtaining these records could take weeks or even months. Your insurance company may also request a Functional Capacity Examination (FCE) or additional lab work or imaging. If your insurance company requests any of these, contact a disability attorney immediately. These tests may not prove your medical condition, may not support your claim, and could even jeopardize it.
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 can receive payment. Again, the timeframe is based on the type of long term disability plan you have.
If your claim was denied and you appealed, the insurance company generally has 45 days to issue a decision once the appeal is received. They may request one 45-day extension if “special circumstances” require additional time. If an extension is requested, you must be notified in writing.
Much like the claim process, more time is added to the process each time the insurance carrier reaches out to the claimant for more information. As long as the insurer is requesting information necessary to deny your claim, more time can be added.
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, during which you will need to gather medical evidence to support your case. If the insurer provided an appeal form with your denial letter, you can fill it out and submit it along with your medical records. It is also advisable to hire a disability lawyer to assist with your appeal.
Once you appeal, the insurance company has 45 days to make a decision. They may also request an additional 45 days if they feel more time is needed.
If you have an IDI policy, you may not need to file an appeal. IDI policyholders have the right to proceed directly to filing a lawsuit. If your IDI claim was denied, consult with an attorney to determine if filing an appeal would be beneficial.
Click to call our Long Term Disability Lawyers today.
Is No News Good News When Waiting for a Disability Approval Letter?
Long term disability delays are not new. Typically, it takes 2-3 months to receive a decision after submitting your initial application. However, this estimate is a best-case scenario; a variety of factors can cause delays. Some of these factors are within your control, while others are not.While waiting for a decision, continue to get medical treatment as recommended by your doctors. Keep your doctors informed about your inability to work due to your medical condition and any symptoms or side effects you may be experiencing from your medications.
Take all medications as directed and follow your doctors’ orders in meticulous detail. Remember, someone might be conducting surveillance on you to verify the severity of your health problems. Also, start considering which disability attorney you might want to consult if your claim is denied.
Contact an Attorney for Legal Advice
The process is often daunting and lengthy, even when you do everything possible to avoid delays. Understanding every aspect of the process may be challenging. Fortunately, the attorneys and legal team at Ortiz Law Firm are available to assist claimants in their fight against insurers.
Ortiz Law Firm specializes in helping people recover the disability benefits they deserve. We handle group Long Term Disability (LTD) claims, individual policy disability claims, and ERISA disability claims. Although we usually do not handle short term disability claims, we may be able to assist you if you also have long term disability coverage. Led by disability attorney Nick Ortiz, our team is prepared to fight for you.
If you need an experienced team of attorneys to help you with your long term disability claim, call Ortiz Law Firm today at (888) 321-8131. We offer free initial consultations, no upfront fees, and a no-win, no-fee guarantee.