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How Long Does a Long Term Disability Claim Approval Take?

long term disability claim timeline

If you suffer from a disabling injury or illness that prevents you from working, you may be eligible for long term disability (“LTD”) benefits.  LTD benefits can provide you with a steady source of income while you are unable to work and help you maintain your quality of life. However, the process of applying for and receiving LTD benefits can be complex and lengthy.


In this article, we will answer some common questions about how long it takes to get approved for LTD benefits, what factors can affect the long term disability claim timeline, and what you can do to expedite your claim.


What Is the Initial Step in Filing An LTD Claim, And How Long Does This Phase Typically Take?


notice of claim is a first step of a long term disability claim

The initial step in filing a long term disability (“LTD”) claim involves several key actions: understanding your policy, gathering necessary documentation, and submitting notice of claim to the insurance company.  This foundational phase is crucial for setting the stage for your claim’s review process and eventual decision.


Before initiating a claim, it’s essential to thoroughly review your LTD policy.  Your policy outlines your coverage details, including the definition of disability according to your insurer, the waiting period before benefits begin, and the documentation required to prove your disability.  Familiarizing yourself with these terms helps ensure that your application aligns with your policy’s requirements, potentially avoiding delays.


Once you understand the relevant provisions of your LTD policy, it is time to give "notice of claim" for your long term disability claim. This is a critical first step in the process of securing benefits. This notice should be submitted promptly, typically within a specified period after the onset of the disability, as outlined in the insurance policy. It must include essential information such as the claimant's details and the relevant dates. Timely and accurate submission of this notice helps ensure that the claim is processed efficiently, minimizing delays in receiving the necessary support.


Once the claim is initiated by a "notice of claim", it is time to supply "proof of claim." "Proof of claim" is the evidence that supports your long term disability claim. Documentation is the cornerstone of a successful long term disability claim. This typically includes:


  • Medical Evidence: Comprehensive medical records, including diagnosis, treatment plans, and notes from your healthcare providers that detail the extent of your disability and its impact on your ability to work.

  • Employment Information: Verification of your employment and earnings, often through pay stubs or employer statements, to establish your work history and income level.

  • Claim Forms: Completed claim forms required by your insurer, which may include an application form, an attending physician’s statement, and an employer’s statement.


Collecting this information can be time-consuming, especially when coordinating with medical professionals and employers to obtain necessary records and statements.  It’s important to get started on obtaining the necessary documentation as soon as possible.


Once you have gathered all required documentation, the next step is to submit your proof of claim to the insurance company.  This submission should be as comprehensive as possible to avoid requests for additional information, which can delay the process.  Ensure that all forms are filled out accurately and that you include all relevant medical evidence and employment information.


The timeline for this initial phase can vary significantly based on individual circumstances.  Gathering documentation is often the most time-consuming aspect, potentially taking several weeks.  For instance, waiting for detailed medical records or coordinating with healthcare providers for specific statements can add time to this phase.


Overall, from understanding your policy to submitting your claim, the initial step can take anywhere from a few weeks to a couple of months.  Being proactive and organized can help expedite this process.  It’s advisable to start gathering documentation as soon as you realize you may need to file an LTD claim and to maintain open lines of communication with your healthcare providers and employer to ensure timely collection of all necessary information.


By approaching this initial step with thoroughness and diligence, you set a solid foundation for your LTD claim, helping to streamline the review process and increasing your chances of a favorable outcome.

 

After Submitting My LTD Claim, How Long Will It Take to Receive a Decision?


ERISA provides strict timelines for LTD claims

The timeframe for an insurance company to review and make a decision on an LTD claim can vary widely based on the insurer, the complexity of the claim, and the completeness of the submitted documentation.  Under the Employee Retirement Income Security Act (“ERISA”), insurers are required to make a decision on a long term disability claim within 45 days of receiving proof of claim, with the possibility of two 30-day extensions if necessary for proper claim processing.  This timeline ensures that claimants receive a timely decision, although the total decision period can extend up to 105 days if the insurer justifies the need for additional time.


During the review period, you can take proactive steps to potentially expedite the process and manage your expectations:


  • Follow Up Regularly: Regular communication with your insurance company can help keep the claim on track and provide opportunities to address any requests for additional information promptly.

  • Stay Organized: Keeping detailed records of all communications, submitted documents, and medical evidence can help address any questions or concerns that arise during the review process efficiently.

  • Seek Support: Consulting with a long term disability attorney can provide valuable guidance and support, especially if complexities or challenges arise during the claim review process.


While waiting for a decision on an LTD claim can be challenging, understanding the typical timeline and factors that can influence the process can help you navigate this period more effectively.  Being proactive, organized, and informed are key strategies for managing the wait and ensuring that your claim is processed as smoothly and swiftly as possible.

 

What Factors Could Delay the Approval of My LTD Claim?


yellow binders of long term disability claims evidence

The approval process for a long term disability (“LTD”) claim can be intricate and time-consuming.  While insurers generally aim to review and decide on claims within a specific timeframe, several factors can cause delays in this process.  Understanding these potential issues can help you prepare more effectively and possibly mitigate delays.


Here are some common factors that could slow down the approval process of an LTD claim:


  • Missing Information: One of the most frequent causes of delays is incomplete applications or missing information.  If your LTD claim submission lacks essential details about your medical condition, employment history, or income, your insurance company will need to request this missing information, prolonging the review process.

  • Additional Medical Documentation: The need for further medical documentation is another significant factor that can delay claim processing.  Insurers may require more comprehensive medical records, detailed physician’s statements, or specific test results to fully understand the nature and extent of your disability.  Gathering this information can take time, especially if it involves coordinating with multiple healthcare providers.

  • Independent Medical Examinations (“IME”s): In some cases, insurance companies may request an Independent Medical Examination (“IME”) to verify your medical condition and level of disability.  Arranging and conducting an IME can add weeks or even months to the claims process, depending on the availability of suitable medical professionals and your ability to attend the examination.

  • Discrepancies in the Claim: Discrepancies or inconsistencies in the claim, whether in the medical documentation, your statements, or between the claim information and the policy terms, can lead to delays.  Your insurance company may require additional time to investigate these discrepancies, request clarification, or seek further evidence to resolve the issues.

  • Legal or Procedural Issues: Legal or procedural issues, such as disputes over policy interpretations, can also delay the LTD claim process.  These issues may arise from complex policy language or disagreements over the applicability of certain provisions.

  • Claimant Response Times: Finally, the speed at which you respond to requests for additional information or documentation can significantly impact the timeline.  Delays in responding or providing requested materials can extend the review process, as your insurance company cannot proceed without the necessary information.


To minimize delays, you should:


  • Ensure your initial claim submission is as complete and detailed as possible.

  • Respond promptly to any requests from your insurance company for additional information or documentation.

  • Maintain open and proactive communication with your healthcare providers to expedite the collection of necessary medical evidence.

  • Consider consulting with a long term disability attorney to navigate the claims process and prepare your claim with as much substantial evidence as possible.


By being aware of and actively addressing these potential delay factors, you can help streamline the LTD claim approval process, reducing stress and uncertainty during this challenging time.

 

Is There a Mandatory Waiting Period for LTD Benefits, And How Does It Affect the Timeline?


waiting area: an elimination period is the time you have to wait for long term disability benefits

The mandatory waiting period for your long term disability (“LTD”) benefits is known as the “elimination period.”  This period acts as a time deductible, beginning from the onset of your disability and typically lasting between 90 to 180 days, although the exact duration depends on your specific policy.  It’s important for you to understand this waiting period for effective financial planning and to set realistic expectations about when support from your LTD policy will begin.  Familiarizing yourself with the terms of your policy regarding the elimination period will help you navigate the LTD claims process more smoothly.


The elimination period significantly influences when your LTD benefits will kick in, with payments not starting immediately upon claim approval but only after this waiting period is fully satisfied.  For example, if your policy includes a 90-day elimination period, your benefits will start on the 91st day of disability.  Some individuals may have short term disability (“STD”) insurance to provide financial support for this period.  Always check the scope of your disability insurance coverage when planning your decision to file your claim.

 

How Do Appeals Work If My LTD Claim Is Denied, And How Much Time Does This Process Add to The Overall Timeline?


If your long term disability (“LTD”) claim is denied, the long term disability appeals process becomes a critical next step to challenge your insurance company’s decision.  This process allows you to submit additional evidence, correct any deficiencies in your initial application, and argue against the reasons for the denial.  Understanding how appeals work, including the associated timeframes, is crucial for effectively navigating this phase.


Upon receiving a denial, insurers typically provide a specific timeframe within which you must file an appeal.  This period is often 180 days from the date you receive the denial notice, but it can vary depending on your policy and whether ERISA applies.  The appeal itself should be comprehensive, including any new medical evidence, testimonies from treating physicians, and, if applicable, legal arguments prepared by an attorney specializing in disability insurance claims.  This is your opportunity to address the reasons for denial directly and strengthen your case for benefit eligibility.


One important aspect of the appeals process that you should be aware of is the role of ERISA, the federal law that governs most employer-sponsored disability insurance plans.  If your plan is subject to ERISA, you must exhaust all of your available administrative remedies, including appeals, before you can file a lawsuit against your insurer in court.  Litigation is a lengthy process that will further draw out any chance at getting your claim approved – often by years.  This also means that your appeal is typically your last chance to present all of the evidence and arguments in support of your claim, as the court will generally not consider any new information that was not part of the administrative record.  


It is highly advisable to consult with an experienced long term disability attorney before submitting an appeal, as they can help you prepare a strong and persuasive case that addresses the legal standards and factual issues involved in your claim.  A long term disability lawyer can also advise you on the best strategy for your situation, gather additional supportive evidence for your claim, and effectively rebut your insurance company’s reasons for denial.


After submitting an appeal, the time it takes to receive a decision can vary.  Insurers usually have a set period, often 45 to 90 days, to review the appeal and make a determination.  However, this can extend further, especially if your insurance company requests additional information or sends your file for review by a medical or vocational consultant.  During this time, maintaining communication with your insurance company and healthcare providers is essential to ensure that any requests for further information are addressed promptly and any third party consultant reports are responded to by your own healthcare team.

 

What Role Does Medical Evidence Play in The LTD Claim Approval Timeline?


Medical evidence is crucial for your long term disability (“LTD”) claim, significantly influencing both the timeline for approval and the outcome of your claim.  


Objective medical evidence that demonstrates your significant physical and/or cognitive impairment is essential in proving to your insurance company the severity of your disability and its impact on your ability to work.  This includes imaging (such as MRI, CT, or X-rays), laboratory and blood tests, biopsy results, and assessments with validity testing such as neuropsychological evaluations, Functional Capacity Evaluations (“FCE”s), and psychological evaluations.  This documentation can greatly streamline the review process by giving your insurance company clear, objective evidence on which to base their decision, potentially leading to a faster approval.


While objective medical evidence is best, you should also include all evidence with your claim, including subjective reports of your symptoms, treatment records, detailed statements from your treating physicians that describe your disability, prognosis, and any work-related limitations or restrictions, personal accounts of how your condition affects your daily activities, and letters from family, friends, or coworkers who can attest to the impact of your disability on your life.


To ensure your medical documentation is processed efficiently, be proactive and thorough in collecting all relevant medical records and evidence.  Communicate clearly with your healthcare providers about the necessity of detailed medical reports that not only confirm your diagnosis but also elaborate on how your condition prevents you from performing your job duties.  Requesting these records and statements early in the claim process can help avoid delays.  By presenting a well-documented and comprehensive medical case from the start, you can expedite the decision-making process and increase your chances of a favorable claim outcome.

 

How Long Does It Take to Start Receiving Benefits After My LTD Claim Is Approved?


After your long term disability (“LTD”) claim is approved, your insurance company will typically initiate the process to start disbursing your benefits.  The first step involves finalizing the details of your benefit payments, which includes confirming the benefit amount based on your policy’s terms, determining the payment schedule (e.g., monthly), and establishing the method of payment (such as direct deposit into your bank account).


This phase may require you to complete and submit additional forms or provide bank account information for direct deposits.  Your insurance company will also inform you about the duration of your benefits, which can vary depending on your policy’s terms and the nature of your disability.


The timeframe for starting to receive LTD benefits after approval can vary, but insurers generally aim to issue the first payment within 30 days of claim approval.  This timeline can be influenced by how quickly you complete any required paperwork and respond to the insurer’s requests for information.  Additionally, remember that the benefit payments will be retroactive to the end of the elimination period specified in your policy, meaning you will receive back pay for the waiting period if you haven’t already been compensated for this time.  Keeping organized records and promptly addressing any administrative requirements from your insurance company can help ensure that you begin receiving your LTD benefits as smoothly and quickly as possible.

 

How Can The Maddox Firm Help Me File My LTD Claim?


The Maddox Firm | Long Term Disability & ERISA

At The Maddox Firm, we specialize in ERISA with a focus on short and long term disability claims.  We offer a full range of services to help you file a successful LTD claim.  With deep knowledge of ERISA law and disability insurance policies, our team provides expert guidance and support through each step of the claim process.


Here are some of the ways The Maddox Firm helps get your LTD claim approved quickly:


  • We Examine Your Policy and Assess Your Claim: Our initial step involves a detailed review of your insurance policy.  Our experienced team assesses your claim by examining the terms, conditions, and provisions of your policy, ensuring a tailored strategy that meets the specific requirements for a successful claim.

  • We Handle All Communications with Your Insurance Company: Dealing with insurance companies can be overwhelming.  The Maddox Firm relieves this stress by managing all communications with your insurer in a prompt and thorough fashion.  From filing the claim to any necessary follow-ups, we present your case clearly and effectively, advocating for your rights.

  • We Help You Obtain Evidence to Support Your Claim: Robust, objective medical evidence is crucial for your LTD claim’s success.  We assist in gathering all necessary documentation, coordinating with your healthcare providers to secure comprehensive records, diagnostic tests, and expert opinions that underscore the severity of your disability.  If needed, we can refer you for additional evaluations to support your claim.

  • We Handle Appeals and Litigation: Should your claim face denial, The Maddox Firm is equipped to pursue appeals and, if necessary, litigation.  Our team has a successful track record in appealing denied claims and litigating against insurers.  We’re committed to fighting for your entitlements, utilizing our legal acumen to challenge denials and advocate for you in court if needed.


A short term disability or long term disability claim can be a complicated process. If you need help during the claims process, with appealing a claim denial, or with litigating a final adverse short term or long term disability decision, The Maddox Firm can help.  The experienced team at The Maddox Firm will examine your insurance policy, correspondence from your insurance company, medical records, and any other relevant documentation in order to give you personalized guidance on how we can help you win your short and/or long term disability claim. Our New Jersey and New York long term disability attorneys help clients nationwide.

 

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