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How long can a determination on a disability claim take?

On Behalf of | Feb 11, 2020 | Erisa

When you are struggling physically or mentally with a debilitating condition that is preventing you from working, waiting for a decision on a disability claim can be frustrating and stressful. It can also put terrible financial strain on any family, especially if you happen to be the primary breadwinner. It may be crucial for you to get a better sense of how long the filing process could take so that you can budget your family’s funds accordingly.

What is the time limit for decision-making?

Under the Employee Retirement Income Security Act (ERISA), disability insurance companies must make decisions on claims within a “reasonable amount of time.” How long is reasonable? Usually, a decision must be reached within 45 days. However, an extension may occur in the following circumstances:

  • The plan needs more time for review. If this is the case, the insurer must inform you within the first 45 days and explain their reasoning for the delay. They may or may not require additional information at this time. If they need additional data, they must give you plenty of time to produce the information—specifically, another 45 days. The deadline for the insurer’s extension on the decision ends 30 days after they receive the requested information or when the additional information is due, whichever comes first. They must to inform you when they plan to deliver a determination.
  • If the plan still needs more time for review, the insurer must get in touch before the initial extension period expires. The only reason to request further time at this point is if they need even more information. Again, the insurance provider must give you 45 days to provide the data requested. The second extension on the decision can last up to 30 days after receiving the requested information or upon the deadline to receive the information, whichever comes first. The insurer must keep you informed of when to expect a decision.

If the company approves your claim, ERISA stipulates that they must deliver benefits within a reasonable amount of time. While ERISA does not define this time limit, the company may outline the terms of issuing payment after claim approval in the summary insurance plan document they provided upon your plan enrollment. It may be helpful to review this document or call the company in question to ask.

If, on the other hand, the disability insurance company denies your claim, your fight for disability benefits isn’t over. Instead, think of this as just another delay. The next step is the appeal, which—it’s important to know—is an extremely time-sensitive part of the process.