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What Happens After You File a Claim for Long-Term Disability?

Legally Reviewed and Edited by: Terry Cochran

If you or someone you know cannot work because of illness or injury or a long-term medical condition that has worsened, you may qualify for long-term disability insurance. This protects you from loss of income and covers related medical expenses.

Living with a disability can be a life-altering and challenging event, especially when it prevents you from returning to work. The process for filing a claim for long-term disability is lengthy and complicated, so understanding what to expect when and after you file a claim can help you navigate this process efficiently.

Here is what’s needed to file a claim and what happens after you file for a claim for long-term disability.

Filing a Claim for Long-term Disability

Often, you can seek long-term disability coverage through your employer or an insurance company. However, it’s critical that you sign up during the initial enrollment period with your employer when you won’t be denied coverage for a pre-existing condition. Even if you receive approval for benefits through your employer, they will probably require you to file for social security disability benefits as well.

In most cases, individual or employer-sponsored long-term disability policies require an elimination period, which is a waiting period between the time your disability began and when you can begin receiving benefits. However, it is essential to note that some policies include a limitation of 24 months on disabilities caused in part by drug abuse, alcoholism, or mental conditions.

When filing a long-term disability claim with the Social Security Administration, you may be eligible for Social Security Disability Insurance (SSDI) or Supplemental Security Income (SSI) benefits. To be eligible, you must have a medical condition that meets the Social Security Act definition of disability: “having an illness or injury that will last at least 12 months or if your condition is terminal.”

There are multiple ways to file for SSDI benefits or SSI benefits, but you must file within the statute of limitations, which is two years in Michigan. When you apply, they will require you to provide information on your job description, income, and medical history. Preparing documentation ahead of time can be helpful, as they might ask you to provide pay stubs, tax records, or scripts from your doctor.

Working with a disability attorney can help you navigate this complicated process and help ensure you’re applying for the right type of long-term disability benefits. The experienced attorneys at Cochran, Kroll & Associates, P.C. will not only help you through this process but can also improve your chances of approval while handling the administrative work, enabling you to focus on adjusting to life with your disability.

What Happens After You File a Claim for Long-term Disability

Once you’ve submitted your claim, the work is not over. Because it’s a complicated process, it’s easy to make mistakes while submitting your claim, especially if you’re not working with an attorney. Accidentally omitting medical evidence or making other mistakes on your application can slow down the process and possibly result in a denial.

Once you have filed your initial claim, your individual or employer-provided insurance plan will investigate whether your disability meets the rules of their policy. This may include reviewing employment records, requesting further medical records, interviewing colleagues, reviewing claims for social security disability insurance, and more.

You’re Approved

Even after receiving approval for long-term disability benefits, the insurance company’s investigation may continue through an eligibility review. Similar to the information gathering you did when you first filed your claim, you may have to provide updated medical records, income documents, decisions on your application for social security disability, and more.

If you are approved for long-term disability benefits through an employer or individual plan after the elimination period, you must continue to provide medical information as requested to continue to receive benefits. If you fail to do so, this could result in the termination of your benefits. If you are disabled for longer than 90 days, most policies do not require you to continue paying premiums.

If you are approved for SSDI in addition to your long-term disability benefits, you may receive a retroactive payment check, which you must pay back to your employer or insurance company.

You’re Denied

Unfortunately, even when you meet all the eligibility criteria, your application may be one of the many long-term disability benefits applications that get denied. This can be a devastating blow to anyone who cannot work because of their disability or illness and needs monetary assistance to survive.

You may be denied for a variety of reasons, including claims by the insurance adjuster that you aren’t actually disabled, you’re disabled but can still perform your job, you aren’t receiving the right treatment for your disability, your disability is because of a pre-existing condition, or you can’t prove that your medical condition is preventing you from doing your job.

Whatever the case, you have the right to know why your claim was rejected, access to your file, and an opportunity to dispute the insurance adjuster’s or medical examiner’s findings before they make a final decision.

If your initial claim is denied or you don’t receive payment after the qualifying period, it’s in your best interest to contact a seasoned disability attorney to begin the appeals process. Many applicants receive approval for benefits through the appeals process, and working with an attorney can nearly double your chances of success.

Long-Term Disability

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Cochran, Kroll & Associates, P.C., is a leading Michigan law firm for long-term disability claims and can help you navigate this confusing and exhausting process. To arrange a free consultation with us, call our law office today at 1-866-MICH-LAW.

Disclaimer : The information provided is general and not for legal advice. The blogs are not intended to provide legal counsel and no attorney-client relationship is created nor intended.

Elena is a writer and communications professional with a genuine concern for the environment. She earned her Bachelor's Degree in journalism with a specialization in environmental studies to complement her passion. In her spare time, Elena enjoys the great outdoors in her home state of Michigan.



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