Dealing with the complex world of disability insurance benefits can be overwhelming, especially when you’re already facing the challenges of a long-term illness or injury. Understanding the timeline for when you’ll get your long-term disability benefits is crucial for your financial stability and peace of mind during a difficult period.

In this article, we’ll explore the various factors that can influence the length of the claims process, strategies to expedite approval, and the importance of qualified legal guidance to protect your rights.

Here’s what we’ll cover:

How long does it take to get your disability benefits?

Once you submit your long-term disability claim to your insurance company, it will typically take at least 45 days to receive the initial decision. It could even take as long as three or four months.

It will typically take at least 45 days to receive the initial decision about your long-term disability claim.

During this time, the insurance company will review your medical records, employment history, and any other relevant evidence you submitted with your claim. Unfortunately, the timeline for determining your eligibility for benefits can vary based on several influencing factors that may be out of your control.

Let’s look at some factors that can impact the duration of the process.

Influencing factors on your disability claim

Your policy’s elimination period

Almost all long-term disability insurance policies have an elimination period, also known as a waiting period. An elimination period is between the “onset date” when you become ill or injured and when you can start receiving your long-term disability benefits.

An elimination period for a long-term disability policy typically lasts between 90 and 180 days. This timeframe coincides with the length of time you can receive benefits for short-term disability, so long-term disability usually picks up where short-term disability benefits leave off.

You must remain continuously disabled during the elimination period to be entitled to benefits. You will only be entitled to benefits after your policy’s elimination period ends.

We recommend you check your policy or contact your insurance company for details.

Learn more: Short-Term vs. Long-Term Disability: What’s the Difference?

The application deadlines and timelines

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 you purchased on your own, the insurer usually has a “reasonable” timeframe to review and decide on your claim. What is considered “reasonable” is determined by state law.
  • ERISA Disability: If you have an ERISA disability plan provided by your employer, your insurer must follow tight timelines. This timeline amounts to 45 days for the initial decision and two additional 30-day extensions if the insurance company thinks they need them. Therefore, it can take up to 105 days to receive your initial decision for an ERISA disability claim. An IDI disability claim can take even longer.

It can take up to 105 days to receive your initial decision for an ERISA disability claim. An IDI disability claim can take even longer.

Learn more: ERISA vs. Individual Disability Insurance

Additional requests from your insurance company

Your insurance company might request additional medical evidence or documentation to support your claim.

Under most disability insurance policies, the insurance company can request that you have an Independent Medical Exam (IME) or Functional Capacity Evaluation (FCE). If your insurance company requests that you take either of these tests, you should contact a lawyer immediately.

The appeal process for challenging a claim denial

If your insurer denies your original claim, you must challenge the denial. This appeal process will only lengthen the period before your insurance pays your benefits. Again, this will depend on the type of long-term disability plan you have.

If you have an ERISA disability plan, you must file an appeal to challenge a denial. You only have 180 days to file your appeal. Once you file your appeal, the disability insurance company has 45 days to decide. They can give themselves an additional 45 days if they need more time.

If you have an IDI policy, you usually do not have an appeal requirement like an ERISA disability plan, so you can appeal or take the matter directly to court.

Read more: 3 Common Reasons Why Long-Term Disability Claims are Denied

How to speed up the claim approval process

While many factors are outside your control regarding the approval of your claim, there are some steps you can take to help avoid any delays.

Be proactive in supplying all of your medical evidence

Because you are disabled due to an injury or illness, the insurance company will request and review your medical records. The more medical issues you have, the more records they will request.

You can speed up this process by obtaining and submitting your medical records as quickly as possible. Don’t wait for the insurance company to request them on their own.

Help your doctor help you

Your doctor’s support is the most critical evidence in your long-term disability claim.

Insurance companies often request that doctors fill out an Attending Physician Statement (APS) as part of the claim analysis. Any delay in these APS forms can impact how long it takes to get your initial decision.

You can help your doctor submit a timely response by ensuring you keep up with your treatment plan. Stay in communication with your doctor so they know your current medical condition(s) when filling out the APS form.

Respond promptly and accurately to requests for information

If your application lacks critical information, your insurance company could delay or deny your claim.

It can also be delayed if you do not comply with the insurance company’s deadlines or requests for any additional information. Any delays on your part mean that the insurance company could take longer to decide and may be entitled to extend the process as the law allows.

If your application lacks critical information, your insurance company could delay or deny your claim.

If you are falling behind, you should seriously consider talking to a long-term disability lawyer to make sure you are not putting your claim at risk.

Why you should consider hiring a lawyer

A long-term disability lawyer can provide invaluable assistance when filing a claim or appeal, particularly in ERISA cases.

The ERISA appeal process is complex and involves strict deadlines that are constantly changing. If you make a mistake with your appeal, there is no way to correct it later. Your appeal is the last time you can ever submit evidence supporting your claim, with very few exceptions to this rule.

You can seek judicial review if your insurance company denies your appeal of a denied ERISA claim. However, the court can only review the information in the insurance company’s claim file. Therefore, as a practical matter, preparing your disability appeal for the insurance company is identical to preparing your case for litigation in court.

An experienced ERISA disability lawyer will know what to prepare for and can help by handling all the complicated details for you. They can help ensure all necessary documentation is submitted correctly and on time, increasing the likelihood of winning your appeal.

Read more: 7 Tips to Help You Win Your ERISA Disability Appeal

Setting expectations for receiving benefits

Unfortunately, there is no definitive answer to how long it will take to get your long-term disability benefits. It depends on the complexity of your case, policy type, how long it takes for your insurance company to decide, and whether you need to appeal a denial.

Once the disability claim is approved and the elimination period has passed, insurance companies are generally required to pay benefits promptly. However, keep in mind the insurance company is not on your side, and they will seek any excuse to delay or deny your benefits.

With the support and guidance of an experienced disability lawyer, you’ll have a much greater chance for a swift, successful outcome.

Want help with staying on top of important deadlines for your claim or appeal? Reach out to Roy Law Group for support.

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