The Long Term Disability Process: From Application to Approved

Before you apply for long-term disability benefits, it is helpful to know how the process will work. After you have exhausted your short-term disability benefits (this is usually a requirement), you can apply for long-term disability benefits. In this article, we walk you through the long-term disability process from application to award.

Applying for Long Term Disability Benefits

Step 1: Request a Copy of Your Long Term Disability Policy and Application From Your Employer

Usually, the human resources department can provide this with no problem. If they cannot, you need to request it in writing and send your request by certified mail. They are required to provide you with this information, and their failure to do so promptly can help your claim.

You may also be able to find the application on the insurance company’s website. Just be mindful when searching for it; make sure you are downloading the most recent application.

Step 2: Complete the Employee Statement Portion of the Application

You will complete this portion with the basic information like name, date of birth, address, family members, date of your injury, the last date you worked, etc. You will also need to list your reason for applying for disability, the medical providers that are providing your treatment, your treatment plans, your medications, and any other form of income that you receive.

You will notice immediately that the form has limited space. This is intentional by the insurance company to deter you from providing everything you want so they can easily deny your claim. Just write or type out your responses on a separate document. later, you’ll save a copy for your record and submit a copy along with your application.

Step 3: Obtain Employer Statement From Your Employer

Your employer will also need to provide information to the insurance company. Typically your employer will provide your hire date, the last date you worked, your earnings history, and your physical and mental job requirements. This can be completed by your human resources department or your payroll and benefits department.

Step 4: Obtain Statements From Your Physicians

The insurance company will require a statement from your treating physicians as well. They will request information such as: when you were diagnosed, details about your symptoms and pain levels, lab results, a list of limitations and restrictions, and details about surgeries and hospitalizations. If you receive treatment from multiple physicians for different conditions, obtain a statement from each physician.

We recommend that you make an appointment with your doctor and have them fill out the form while you are present. It is not uncommon for doctor’s offices to misplace paperwork or not treat it as a priority. This could delay your claim or even cause you to miss a deadline, which can cause an automatic denial. [Note: Most doctor’s offices will charge you a fee to complete this paperwork. It is totally within each doctor’s individual discretion (a) whether to charge a fee and/or (b) how much to charge.]

Step 5: Submit Additional Supporting Documents

A common mistake that people make is assuming that the insurance company will gather all the medical information themselves. While they will gather the majority of your medical records, they will not gather additional documents that would support your claim. If you have documents that you think will support your claim, submit those as well. Just make sure anything you submit will not harm your case. Check out this article on harmful elements to be sure you don’t submit bad information.

Step 6: Review and Double-Check Your Application and Supporting Documentation

Before you submit your application, take some time to read through your application and make sure all the information is correct. The number one reason a claim is denied is due to missing or incorrect information.

Here are some examples of what to look for:

• Did your doctor note your pain levels on your forms?
• Are all your medications related to your disability listed?
• Did you write down the correct mailing address for your doctor’s office?

Step 7: Copy and Organize

After you double-check your application, make a copy of everything. Create a file or use a binder to neatly store all of your documents related to your disability claim. This will include all the letters from the insurance company, letters from your employer, your medical records, and a list of medications. Keep everything organized and make a copy of everything before you send it. Sending your application by certified mail is a secure way of sending all these documents to your insurance company with the benefit of knowing for sure they received them. Save that mailing receipt as well.

If your application is approved, the insurance company will pay out your claim. Unfortunately, many applications are denied.

What Do You Do If The Insurance Company Denies Your LTD Claim?

If your claim for benefits has been wrongfully denied, improperly delayed, or unfairly terminated it is important for you to be familiar with the appeal process. The more you know about LTD appeals, the better equipped you will be to submit an appeal quickly and efficiently to avoid further delays. We know your efforts are better spent on healing and getting better- not battling with your insurance company.

Determine If You Have An Individual Policy or Group Policy

You must first determine how you obtained the long-term disability policy. Which one of the following applies to you?

• You purchased an individual disability policy on your own directly from an insurance broker or representative;
• You are a government employee and the government provides LTD coverage as a benefit of employment;
• You are a church employee and the church provides LTD coverage as a benefit of employment; or
• You have coverage as part of a group long term disability plan with your employer.

If you have a group policy, you may be required to file one or more administrative appeals internally with the insurance company before filing a lawsuit against the carrier in federal court. The Employee Retirement Income Security Act of 1974 (“ERISA”) governs group policies and requires you to exhaust your administrative remedies before you can file a lawsuit. 

However, if you have an individual disability insurance policy, or if you are a government or church employee, then you may not have to file any appeals directly with the insurance company before filing a lawsuit against the insurance company in state court for the wrongful denial or termination of benefits.

This is why it is important to discuss your legal rights with an experienced LTD lawyer – to help you determine what you are required to do before filing a lawsuit.

Why Is It So Important That I Appeal?

The internal appeal process allows the insurance company an opportunity to correct its mistakes and avoid a lawsuit. If you do not give the insurance company the chance to right its own wrongs first, most courts will not allow your lawsuit to proceed.

The internal appeals process is also a very important opportunity for you, the disabled claimant. It gives you a chance to load your claim file with information supporting your disability claim and to correct any misconceptions. It is imperative that you submit everything that may possibly help prove your disability and your credibility. (See “How do I appeal my own denial of disability benefits?”)

Review Your Denial Letter

When a long-term disability claim is denied or benefits are cut off, the plan administrator must send you a notice, either in writing or electronically, which includes a detailed explanation of why your claim was denied and a description of the appeal process.

In addition, the denial letter must include the plan rules, guidelines, or exclusions (such as a pre-existing condition exclusion) that were used in the decision or provide you with instructions on how you can request a copy of these documents from the plan. The denial letter may also include a specific request for you to provide the plan with additional information in case you wish to appeal your denial.

The Long Term Disability Appeal Process

Let’s assume that you are required to file an administrative appeal. A lot of work goes into filing an appeal and your time to file the appeal an LTD denial is limited. Thus, whether or not you hire an attorney to represent you, you should take immediate action and take the following steps in appealing a long-term disability denial.

Step 1: Initial Appeal

Typically, you have 180 days from the date you receive the notice of denial or termination to submit your appeal.

Step 2: Appeal Review

The insurance company typically has 90 days to issue a decision on your appeal. About 50% of claimants are “put on claim” after the first appeal. This means the claim was approved (or reinstated) and benefits are payable.

Step 3: Second Appeal (If Applicable)

Most disability insurance policies (but not all) allow a second appeal. The process and timeline for a second appeal is similar to the first appeal.

Step 4: Second Appeal Review (If Applicable)

The process and timeline for the second appeal review is more or less the same as the first appeal review.

Step 5: Litigation

Many disability insurance claims go to federal court. The court process typically takes 1-2 years.

Request a Free Consultation with an LTD Lawyer

Florida attorney Nick A. Ortiz is an experienced long-term disability attorney who is compassionate and dedicated to defending the rights of disabled individuals. We understand the struggle of living with a chronic disease, and we are here to help. For a free case evaluation with an experienced LTD attorney, complete the form to the right or call (888) 321-8131. Most inquiries will receive a response within 24 hours of submission.