The Long-Term Disability Benefits Claim Process

Begin the Process

The long-term disability benefits claim process begins with an application package, usually comprised of two to three forms, depending on who owns the policy.

If you have access to long-term disability benefits through your employer, there will be three parts to your application package: 1. employer’s form; 2. your form; and 3. medical report. It also helps to submit any other medical evidence, such as specialist reports or diagnostic imagining, that establishes that you are unable to work.

You will submit your long-term disability application package within a specified period following the “qualifying period”. The qualifying period for many employees coincides with the period of short-term disability. It is important to know the deadlines to submit your long-term disability application or else your long-term disability insurer will likely deny your claim due to a technicality, rather than the merits of your claim.

Total Disability

Once your long-term disability benefits application package is submitted your disability insurer will review your application and either approve your application or deny it. Typically, a denial will be because you do not meet the definition of “totally disabled” as defined in the policy.

Most long-term disability insurance policies will have a two-part test for total disability: the first part requires that you cannot perform the tasks of your own employment during the qualifying period and the following two-years; and the second part kicks in after the qualifying period and the two-years and requires that you are unable to perform the tasks of any employment for which you are qualified or may reasonably become qualified by training, education or experience.

Appeal

If your disability insurer denies your claim, it will normally offer you an opportunity to appeal the decision. This is an internal appeal to the disability insurer – you’re essentially asking your disability insurer to change its mind after its already decided that you do not meet the definition of total disability. This is an informal appeal process involving you and your insurance company. This appeal process usually involves the submission of further medical information that the insurance company has not yet reviewed.

In our experience, once a disability insurance company decides you are not totally disabled, it is very difficult to convince it to change its mind.

Luckily, if you can’t get your insurance company to change its decision to not approve your long-term disability application, and you have supportive medical evidence that you are totally disabled from working, you can start a lawsuit against your long-term disability insurer for long-term disability benefits that have been improperly denied.

Get Help

There are time limits to start a lawsuit against your long-term disability insurer. So, if you’re in a situation where you have submitted all of your supportive medical evidence and your insurance company refuses to approve your long-term disability application, then you need to consult an experienced disability lawyer who will help you decide on what the next steps should be in your long-term disability benefits claim process and ensure that you comply with timelines to start a lawsuit against your insurance company.