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    The Long-Term Disability Claim and Appeal Process

    The Long-Term Disability Claim and Appeal Process

    Filing a long-term disability (LTD) claim can be complicated. It starts when a person sends a “notice of claim” to their insurance company. The insurer then provides claim forms, which must be filled out and returned with supporting evidence. After reviewing everything, the insurer decides if the person meets the policy’s definition of disability and qualifies for benefits.

    But the process often doesn’t end there. Many LTD claims are denied, and claimants may need to file an appeal, or even a lawsuit, to get their benefits. Knowing how the LTD claim and appeal process works can make it easier to secure the support they need.

    In this article, CCK Law will discuss:

    Who We Are: Chisholm Chisholm & Kilpatrick is a leading public interest law firm based in Providence, Rhode Island. Since 1999, we have been helping long-term disability claimants across the United States receive the benefits they need through claim assistance, appeals, litigation, and education.

    Why Would Someone Need to File for Long-Term Disability Benefits?

    Individuals typically seek long-term disability benefits when a severe illness or injury prevents them from working for an extended period.

    Many conditions can qualify for such benefits, including:

    The above list is not exhaustive. Many conditions may qualify for LTD benefits, but claimants must prove to their insurers that their conditions disable them under the specific terms of their policies.

    Note: Filing for LTD benefits—if available to them—can help protect a percentage of their pre-disability earnings, usually between 60 and 80 percent. Long-term disability coverage may be obtained either through a person’s employer or directly from an insurance company. Regardless of a person’s profession, these benefits can allow them to focus on their well-being.

    What Are the Three Stages of the LTD Claim and Appeal Process?

    3 Stages of the Long-Term Disability Claim Process

    There are three stages of the LTD claim and appeal process. These stages are:

    • The Initial Claim
    • The Administrative Appeal
    • Litigation

    This article will summarize each of these stages, but be sure to check out each individual stage’s article for more information.

    Need help? CCK Law may be able to assist you at any stage of the LTD claim and appeal process. Whether you are filing your initial claim, administrative appeal, or lawsuit, we are prepared to help you get the disability benefits you need.

    What is the Initial Claim?

    The initial claim is the first stage of the LTD process. During this stage:

    • The claimant sends their insurer a “notice of claim”
      • The notice of claim initiates the process and notifies the insurer that the individual wishes to file a formal claim for benefits
    • The insurance company sends claim forms to the claimant to complete
    • Claimants gather evidence and submit it along with their claim forms to their insurer
    • Insurers review all documentation and evidence

    Common examples of evidence include:

    • Detailed medical records
    • Physician reports
    • Witness statements
    • Vocational evaluations
    Note: Evidence and documentation should show how the claimant’s conditions and symptoms meet their policy’s definition of disability, which will be an “own” or “any occupation” definition.

    Additionally, when filing an LTD claim, it’s important to understand key rules and timelines:

    • Know your deadlines: Missing a deadline could mean the insurance company denies your claim. Be sure to submit your notice of claim and proof of claim within the time limits in your policy.
    • Understand decision timelines: For ERISA-governed claims, insurers generally have 45 days to issue a decision. They may also take up to two 30-day extensions in certain circumstances, meaning you could wait as long as 105 days.
    • Be prepared to appeal: If the insurance company denies your initial claim, you have the right to file an administrative appeal.
    • Stay in touch with your doctors: Keeping your doctors informed about your condition helps them provide strong medical statements to support your claim.
    5 Reasons Why Long-Term Disability Claims Are Denied

    What is the Administrative Appeal?

    If your initial LTD claim is denied, then the next step is the administrative appeal. Here’s what to know about this stage:

    • Final chance to submit evidence: Under ERISA, the appeal is usually the last opportunity to add supporting evidence to your claim.
    • Appeal deadlines: Claimants generally have 180 days to file an appeal.
    • Key steps during this period:
      • Read the denial letter carefully to understand the reasons for the denial, and
      • Gather additional or updated evidence that directly addresses those reasons
    • Consider legal help: The appeal stage is often the best time to contact an LTD attorney who can strengthen your appeal.
    • Be prepared for another denial: Insurers can still deny appeals. If that happens, filing a lawsuit may be the next step.

    What is Long-Term Disability Litigation?

    Litigation differs based on the type of policy you have. Key differences include:

    State-Law-Governed LTD Claims ERISA-Governed LTD Claims
    May not require you to file an appeal before filing a lawsuitRequires claimants to exhaust all appeals before filing a lawsuit.
    Typically filed in state courtTypically filed in federal court
    Subject to state law, not federal lawSubject to federal law, not state law
    Deference is typically not shown to insurersDeference often shown to insurers
    Jury trials allowedTypically, no jury trials; a judge alone rules on the case
    New evidence may be presentedNo new evidence may be submitted (except in rare cases)
    Ability to sue for other damages may be allowedMay be only sue for benefits; claimants cannot seek extracontractual damages

    Note: Many lawsuits over LTD benefits do not make it to judgment. Insurers may offer a lump-sum settlement to resolve the dispute, though claimants are not required to accept such offers. Settlement offers should be carefully considered before acceptance, as insurers’ offers typically involve releasing all claims and other terms.

    Other Considerations for Long-Term Disability Claimants

    If you are considering an LTD claim, consider researching other aspects of the LTD claim and appeal process, like these:

    Long-Term Disability (LTD) 101

    Frequently Asked Questions

    How do I start a long-term disability claim?

    To begin a claim, individuals must submit a “notice of claim” to their insurer. This notice formally notifies the insurance company of the claimant’s intent to file a claim for disability benefits. Once submitted, the insurer will send the claim forms to the claimant to complete.

    What happens if the insurance company denies my LTD claim?

    If the insurance company denies your initial claim, then you have the right to file an administrative appeal. The appeal process allows you to submit additional medical evidence, expert opinions, and other supporting documents to strengthen your case.

    How long does the LTD appeal process take?

    The timeline varies depending on the insurer and the complexity of the case. However, under ERISA, claimants typically have 180 days to submit their appeal. Moreover, insurers have 45 days to render a decision, though they can take up to two 30-day extensions.

    Do I need a lawyer to handle my LTD claim or appeal?

    You are not required to hire an attorney to help with your claim or appeal. However, many LTD claimants choose to do so, especially during the appeal stage. An experienced attorney can help build the strongest possible record and increase the likelihood of securing or reinstating benefits.

    Need Help? Call CCK Law

    The LTD claim process can be overwhelming, especially while managing a serious condition.

    Chisholm Chisholm & Kilpatrick has:

    • Over 25 years of experience
    • Helped claimants at all stages—claims, appeals, and litigation
    • Fought against all major insurers

    Contact Us:

    • Call (800) 544-9144 for a free case evaluation.
    • Our team will review your case and determine how we can help.
    Long-term Disability Claims Process Overview