How Long can a Long-Term Disability Appeal Take?

Anyone who has ever filed an insurance claim, regardless of the type or basis, understands how difficult companies make it for insureds to actually collect the benefits they pay premiums to secure. Long-term disability claims are no different, and in fact, often take considerably longer to work through the internal system disability providers utilize to vet and approve claims. Sadly, a large number of disability claims are denied upon the initial application, and an appeal process must be initiated in order for the claimant to keep the claim active and potentially payable. The internal review disability insurers impose on an appeal of a denied claim are highly technical and subject to a number of strict deadlines. Thus, working with a long-term disability lawyer from the outset will reduce the possibility of delay or loss of rights because information was missing, or a key deadline missed. Understanding the length of a long-term disability appeal, and an alternative an insured should consider that is more likely to bring a satisfactory outcome are important issues when disability hits.

Internal Review/Appeal Process

Using a disability lawyer to file a disability claim and handle the appeal of a denial is not required, and insurance companies hope that disabled claimants decide to work through the process alone. To start, forms must be obtained and completed by the disabled applicant and his or her employer, and medical evidence from treating physicians submitted, which almost always must be updated. Getting all these forms together and properly completed is a huge task to take on alone, and even gaining access to these necessary forms can be a challenge. However, the disability package is not complete until all these items are submitted, which leads into one of the more common reasons for an initial denial – missing information.

The two other frequent grounds for a denial are not meeting the definition of disability and failing to respond to the insurer’s request for a medical examination by one of its doctors. Once denied, the length of time an applicant has to appeal is 90 days, and once submitted, the appeal goes to internal review for additional consideration. Three levels of appeal and review are normally built into the insurer’s process, and the denial letter will explain why the claim was not approved and how to appeal. However, the levels of appeal allotted by disability insurers to handle denied claims normally take years and effectively close the window the claimant has to take legal action, which is two years.

Avoiding the Hassle and Undue Delay

Insureds who go through the appeal process without benefit of a lawyer are rarely aware that a clock is ticking that gives them just two years to file a disability claim in court. Once this window closes, it becomes increasingly difficult to overcome a denial, though technical legal arguments may be offered, such as the insurance company did not provide a “clear and unequivocal denial,” but there is no guarantee of success. Instead of taking long periods to find out how the insurance company will decide the claim, which also gives it the ability to build a stronger case against approval, consider filing a court action immediately. The length of a long-term disability appeal works against obtaining court relief if approval is never granted and serves to delay the benefits the insured should be receiving, money often needed to keep families afloat. Working with a disability lawyer from the beginning, who can assess the effectiveness of internal appeals over direct court action, is key to obtaining benefits faster and at a higher rate of success.

Contact a Long-Term Disability lawyer

Appealing a denial of disability coverage is complicated and implicates other legal factors insurance companies will not tell you. Hiring a dedicated disability lawyer to advocate on your behalf can make the difference between frustrating months and years to getting the money you need and deserve sooner. Taking action early is essential to retaining the highest likelihood of success, and legal counsel should be one of the first calls made once a disabling condition is discovered.