The process of filing a long-term disability claim can be stressful and frustrating at an already difficult time. Managing deadlines, wading through complex jargon, and possibly even facing a denial can leave you with a lot of questions and uncertainty.

At Roy Law Group, we handle disability insurance claims and appeals every day. We’ve prepared some answers to some of the most frequently asked questions from our clients here, and we’re here for you if you still have questions. You don’t have to go through this process alone.

Here’s what we’ll cover:

When should I file a long-term disability claim?

You should file a long-term disability claim as soon as you become unable to work due to a serious medical condition.

Typically, you have a period of 60 days to submit your claim for benefits following a diagnosis or injury that affects your ability to work. You cannot miss this deadline, or the insurance company can deny your claim for lack of timely notice. It is always better to file your claim early and then provide any additional information as you gather it, rather than miss the filing deadline.

Don’t miss these 5 Tips for Filing a Long-Term Disability Claim.

Doctor in a medical environment with a stethoscope and a patient in the backgroundWhat is needed from my doctor in order to support my claim?

Your doctor will need to provide detailed medical documentation that outlines your condition, treatment plan, and how your illness or injury affects your ability to work. This may include medical records, test results, and an Attending Physician Statement (APS) explaining your diagnosis and prognosis, and attesting to your inability to work.

It’s important that the information from your doctor clearly demonstrates the severity of your condition and the limitations and restrictions it imposes on your daily activities and job responsibilities.

How long does the disability claims process take?

The claims process can vary in length, but it typically takes at least 45 days to receive the initial decision about your claim. It could even take as long as three to four months.

Factors that can influence the timeline include:

  • The complexity of your case
  • The completeness of your documentation
  • The insurance company’s workload and corresponding tolling periods while it is gathering evidence
  • The type of policy you have (e.g., ERISA or Individual Disability Insurance)

You can help to expedite the process by being proactive, organized, and filing all required documents promptly.

It’s also a good idea to follow up regularly with your insurance company to check on the status of your application.

Learn more: How Long Does It Take to Get Long-Term Disability?

What documentation do I need to submit with my claim?

Along with your application, you will typically need to provide medical records, treatment plans, and any other relevant documentation from your healthcare provider. You may also need employment information, such as pre-disability income and a current job description.

This information helps the insurance company assess the severity of your condition, its impact on your ability to work, and whether you can perform the duties of the occupation you were performing when you became disabled. This is typically referred to in your policy as your “own occupation” or “regular occupation.”

Learn about Own Occupation vs. Any Occupation.

What if my claim is denied?

If your claim is denied, don’t lose hope. You have the right to appeal the decision.

For starters, review the denial letter carefully to understand the reasons for the denial, make a list of issues you disagree with, and gather any additional evidence that may support your case.

If you miss the deadline to appeal, you are usually barred from bringing any further action to recover your benefits.

You must adhere to strict deadlines during an appeal, so make sure you act quickly and don’t procrastinate. If you miss the deadline to appeal, you are usually barred from bringing any further action to recover your benefits.

Filing a long-term disability appeal is a lengthy and complicated process that heavily favors insurance companies, especially appeals involving ERISA. We strongly recommend that you consult with a legal professional who specializes in disability claims to guide you through the appeals process.

Learn more: How to Appeal a Long-Term Disability Denial

What are some insurance company tactics to watch out for?

Insurance companies are notorious for shady tactics during the claims process, like:

  • Delaying disability claims
  • Using complex and confusing jargon with no clarification on what you need to submit your claim
  • “Losing” or allegedly failing to receive information
  • Twisting your words during telephone or in-person interviews

They might even employ surveillance tactics and private investigators to observe your daily activities or perform a deep dive on your social media, looking for any evidence that contradicts your claim.

Read about our client who was denied benefits because of a social media post: Flaaen v. Principal Life Insurance.

In our decades of experience in going up against insurance companies, we have seen all the tricks they try to pull. They may act friendly during the claims process, but they are not on your side, and they will look for any excuse to deny your claim.

It’s important to take control of the claims process and not rely on the insurance company to treat you fairly. Understand your policy, keep detailed records of all communications, and seek legal advice from an expert if you have questions, as that is the only way to ensure your rights are protected.

Can I work while receiving long-term disability benefits?

In many cases, you can work part-time while receiving long-term disability benefits, but this depends on the specific terms of your policy. Some policies allow for a trial work period, while others may reduce your benefits based on your earnings. Always check with your insurance provider to understand the rules regarding working while on disability.

Should I not sign a severance/termination agreement if I plan to pursue a disability insurance claim?

If you are considering pursuing a disability insurance claim, you should approach any severance or termination agreement with caution. Signing such an agreement may limit your ability to file a claim or could affect the amount of benefits you receive.

Before signing anything, take the time to read the document carefully and consult with a legal expert who specializes in disability insurance. They can help you understand the implications of the agreement and advise you on the best course of action.

When should I hire a long-term disability attorney?

It’s a good idea to consult with a long-term disability attorney early in the claims process, especially if you expect complications or are feeling overwhelmed. Many attorneys, including Roy Law Group, do not charge for initial consultations, so there is no harm in reaching out to ensure you are on the right track.

If your disability claim is denied, the insurance company is stalling, or you receive a request for a Functional Capacity Evaluation or Independent Medical Examination, you should consult an attorney right away.

Having an experienced attorney handle all the details for you can give you more peace of mind so you can focus on taking care of yourself. Your health and well-being are what matter most, so don’t hesitate to ask for help.

Still have questions?

At Roy Law Group, we understand the complexities and challenges that come with long-term disability claims and appeals. Our firm is 100% dedicated to disability insurance law, and we have the expertise and experience to handle every step of the process for you. If you have questions or need help with your claim or appeal, don’t hesitate to reach out to us for a free consultation.

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