How Does the Long-Term Disability Insurance Claim Process Work?
At Disability Insurance Law Group, our insurance claims lawyers represent individuals in Florida and nationwide pursuing long-term disability claims with their insurance providers.
Our national long-term disability claims attorneys understand that time is of the essence when filing these crucial claims, especially when pursuing an employer-provided policy typically governed by ERISA, as the filing deadline requirements are generally more stringent than those for a private policy.
Outside of the insurer’s essential claim filing requirements, if you are pursuing disability benefits, time is of the essence because they provide a source of income when you cannot work due to a disability. Without this financial support, you and your family may struggle to meet basic living expenses, like housing, food, and medical care. Access to benefits quickly can help alleviate financial stress and prevent individuals from falling into debt or facing economic hardship.
To get started, most people review their disability insurance policies to understand better what is covered so they are not surprised when the claim process begins. Unfortunately, the surprises typically begin immediately, starting with the coverage details. Disability insurance policies and benefit plans are often written in confusing language, making it difficult to understand if the policy covers your illness or injury.
Next, the claim process is designed to be complex, confusing, time-consuming, and often intimidating. One missed deadline, lacking detail, or inadvertent omission can derail your claim and result in a dispute or denial. We can help.
Here, we discuss how the long-term disability application process works and how we can help.
What is the Process for Filing a Long-Term Disability Claim Across the U.S.?
The long-term disability insurance claim process begins when the insured individual becomes disabled and cannot work due to an illness, injury, or medical condition (link to new medical conditions page). Depending on whether you have an employer-provided disability insurance policy or a private one, the deadlines and submission requirements may differ.
In general, the long-term disability claim process should include:
- Reviewing the Information from Your Plan
Before applying for benefits, review the Summary Plan Description to ensure you meet the plan’s requirements for disability and understand the claim-filing procedures. Sometimes, claims procedures are contained in a separate booklet. If you do not have a copy of your plan’s Summary Plan Description or claims procedures, contact your plan’s workplace administrator or private insurance representative to obtain a copy.
- Filing a Claim
The Summary Plan Description or claims procedure booklet must include where to file, what to file, and whom to contact if you have questions about your plan.
The disabled individual or their attorney completes and submits a claim form to the insurance company and any required documentation, including medical records, treatment notes, and supporting evidence of disability.
- Insurance Claim Review
Upon receiving the claim, the insurance company reviews the documentation to determine eligibility for benefits. The insurer may request additional information or medical records from the claimant’s healthcare providers to support the claim.
The insurance company evaluates the claim based on the policy terms, including the definition of disability, waiting period, and any exclusions or limitations.
- Insurance Decision on Claim
After completing the review process, the insurance company decides on the claim. If the claim is approved, the insured receives long-term disability benefits according to the policy’s terms.
If the claim is denied, the insurance company sends a denial letter to the claimant outlining the reasons for the denial and any options for appeal.
- Appeals Process
If the claim is denied, the claimant can appeal the decision. The appeals process typically involves submitting additional evidence, like medical records or opinions from healthcare providers, to support the claim. The insurance company may review the appeal, potentially involving independent medical or vocational experts.
If the appeal is successful, the claim may be approved, and benefits may be awarded retroactively.
If the appeal is denied, the claimant may have further options for escalation, including mediation, arbitration, or filing a lawsuit against the insurance company.
- Ongoing Monitoring
Once long-term disability benefits are approved, the insurance company may periodically review your condition to ensure continued eligibility for benefits. As part of the ongoing monitoring, you may be required to provide updated medical documentation or undergo medical evaluations.
It will come as no surprise that the insurance company has an advantage when reviewing your long-term disability claim. Our attorneys at Disability Insurance Law Group are dedicated to leveling the playing field and aggressively fighting to obtain the benefits our clients deserve — no matter where they live or work in the U.S.
We can help you assert your rights at any point during the insurance benefits claims process, whether you are applying for benefits, in the middle of the review process, appealing a denial, filing a lawsuit against your insurance company, or are interested in negotiating a lump-sum buy out of your claim.
Contact Our Nationwide Long-Term Disability Insurance Claims Attorneys Today
Contact our skilled nationwide long-term disability insurance claims attorneys today by calling 954-989-9000 or online to schedule a completely free and confidential case assessment. We can use our over 50 years of combined experience to help you, no matter where you live or work in the U.S.