The Factors That Affect the Length of a Long-Term Disability Claim

If you’ve filed for long-term disability (LTD) benefits or you’re considering it, one of the first questions you probably have is: how long will this actually last? 

Well, the answer isn’t straightforward because several key factors influence how long your LTD claim will stay active. The average duration for a long-term disability claim is about 34.6 months. But that’s just an average; some claims wrap up in a few months, while others extend for years, even decades. 

Most people tend to turn to long-term disability lawyers from Sandstone Law Group. Not only do they give you a more realistic timeline to expect, but they also know how to position your case to reflect the full extent of your disability, so the insurance company fully understands why you can’t return to work. 

Their guidance ensures that your medical records, doctor opinions, and all related paperwork are submitted clearly, accurately, and completely.

Nonetheless, these are the factors that affect and determine the timeline of your long-term disability claim:

The Severity of Your Disability  

The more serious your disability, the longer you’re likely to need benefits. If your disability makes it impossible to do basic tasks, then it’s going to be a longer recovery process. On the other hand, if your condition is temporary or responds well to treatment, your benefits might stop sooner.

Insurance companies look at things like your medical history, diagnostic tests, specialist reports, and how your condition affects your ability to work. The bigger the impact, the longer your claim typically lasts.

Your Policy’s Terms  

Every long-term disability policy is different, and the details in your policy set the upper limits of how long benefits can last. Most group LTD plans sponsored by employers come with a fixed benefit period. The common timeframes include:

• Two years: Some plans stop benefits after two years if you can’t do your job, even if you’re still unable to work in another field.
• Five years or ten years: Others provide coverage up to five or ten years, depending on how the disability impacts your ability to work in any capacity.
• To age 65 or retirement: The most comprehensive plans continue payments until you reach age 65 or your full Social Security retirement age. But if you become disabled after age 60, the benefit period may be reduced to just a few years.

You should review the summary plan description or your certificate of coverage to know exactly what your policy allows. If you’re unsure, a disability lawyer can explain it clearly and tell you what to expect.

Exclusions, Limitations, and Offsets

Policies often come with exclusions and time limits. Pre-existing conditions or mental health issues may be capped at 24 months regardless of severity. Even if your disability continues, the insurance company could legally stop payments once the limit is hit.

Also, if you’re receiving Social Security Disability Insurance (SSDI), most LTD plans reduce their payments by the amount you get from SSDI. While this won’t change how long your benefits last, it will affect how much you get each month.

The Appeals Process  

If your claim is denied, you generally have 180 days to file an appeal (under ERISA). Once submitted, the insurer has 45 days to decide, with the option of extending another 45 days if necessary. In total, the appeal process can last up to 9 months.

During an appeal, no new information can be added after submission, so your initial appeal has to be airtight. If your policy isn’t covered by ERISA, you may still appeal, but timelines and procedures are looser. Expect it to take even longer in those cases.