Long-term disability insurance (LTD) policies are intended to provide partial replacement of income when an individual is forced to leave the workplace earlier than planned due to disability. While some disabilities are permanent and career-ending, others resolve in a period of time longer than that typically covered by short-term disability (STD) insurance, but well before retirement age. Insurance providers conduct an extensive review process for long-term disability claims at initial filing. In many cases, however, they also carry out long-term disability review procedures at regular intervals over the life of the benefit period. Understanding LTD claim review processes can help you prepare for what happens during an LTD claim review, whether initial or to determine the continuation of your long-term disability benefits.
How Often Is Long-Term Disability Reviewed?
Most people applying for long-term disability benefits are likely aware well in advance that their submitted claims will be subject to review by the insurance company’s adjusters, even if they are not familiar with the details of this long-term disability review procedure. What many may not realize is that their eligibility for continued benefits will in many cases go through a periodic review process even after the claim has received initial approval.
The frequency with which you need to go through this recurring type of long-term disability review procedure will depend on the terms specified in your policy. Some insurance providers review active claims as seldom as once per year, whereas others may require semi-annual or even quarterly reviews. Understanding LTD claim review processes can make navigating these procedures easier, regardless of how often they are required.
How Long Does LTD Take To Get Approved?
What happens during an LTD claim review to assess an individual’s continued eligibility for benefits under an already approved initial claim tends to move faster, and require fewer steps from the policyholder, than the review conducted when a disabled person first files their claim for long-term disability benefits. However, a number of factors can trigger more detailed scrutiny. Some of these, such as gaps in the documentation many people are required to file regularly as part of their obligations for periodic benefits renewal, are within the policyholder’s control. Others, such as protocols within the insurance company mandating randomized audits of approved claims, are not.
Understanding LTD Claim Review Processes: Internal Audits
Depending on how your insurance provider carries out its review process for long-term disability claims after their initial approval, an individual may or may not be personally involved in what happens during an LTD claims review from the start. In some instances, the person receiving benefits may not even be aware that their case is under review unless the insurance adjuster requests additional information as part of their audit.
Understanding LTD Claim Review Processes: Factors That Can Cause Delays in Renewal
These factors can make it difficult to estimate how long it takes to be approved for continued benefits, but as a general principle any significant changes in your condition or inconsistencies in your medical records can prolong the long-term disability review procedure. They can also make a termination of LTD benefits more likely, and in that case the appeal process to reverse the LTD termination can often extend the timeline considerably compared to what happens during an LTD claim review that receives approval on the basis that the individual’s status is unchanged from previous assessment.
What Happens When Your Disability Is Reviewed?
Depending on the terms of the policy, an individual may be responsible for initiating a benefit renewal process on a regular schedule. In other instances, a review may be initiated by the insurance provider. A long-term disability review procedure of this type may sometimes also be called an audit. In many respects renewals and reviews may be virtually interchangeable, but a company that uses both terms is likely drawing some practical distinctions in the ways they are carried out.
Review Process for Long-Term Disability Claims: Benefit Renewals
Under this model, the default assumption in most cases is that the disability benefits are set to expire automatically after a certain period of time, specified in the policy. The disabled person is responsible for keeping track of these timelines and filing the required forms and medical documentation as often as necessary to comply with the policy’s terms regarding renewal of benefits.
Failure to meet these requirements can result in an expensive and stressful termination of benefit payments. Even if you are able to get the termination reversed on appeal, the sudden loss of income can have long-range consequences for your financial management strategies. Understanding LTD claim review processes that apply to benefit renewals under the terms of your policy is therefore critical to avoiding the gaps in income long-term disability insurance is intended to prevent.
Long-Term Disability Review Procedure: Audit by Insurance Adjuster
What happens during an LTD claim review initiated by the insurance provider may be somewhat different, especially in the early stages of the long-term disability review procedure. In these scenarios, the disabled policyholder may not be responsible for timely filing of documentation to initiate the review procedures. However, the review process for long-term disability claims started by the insurance provider can often involve a more detailed scrutiny than that associated with benefit renewals, although there are variations in how insurance companies determine the depth of examination for both benefit renewals and claim reviews.
The insurance adjuster reviewing the case file may request substantial documentation, and in some cases you may be asked to go through an independent medical examination (IME), similar to the one you likely underwent when first submitting a long-term disability claim. Always respond promptly to any requests for medical evidence or other forms of documentation, as lack of evidence to demonstrate an individual’s continuing disabled status is a common reason for LTD insurance providers to terminate benefits.
What Is the Purpose of Periodic LTD Claim Reviews?
Insurance actuaries are responsible for developing assessments of risk to inform decisions about whom to accept for coverage, which conditions to exclude or restrict to riders, and how much to charge for premiums. In a similar way, insurance adjusters have the job of finding reasons to deny claims. In many cases, the impact of this role is felt most dramatically in the initial decision to approve or deny a claim for long-term disability benefits. For understanding the LTD claim review process, the difference is that the focus in post-approval review typically is on determining whether the person receiving benefits still meets the policy’s criteria for disability.
Individuals suffering from limited-duration disabilities, such as the side effects of some cancer treatments, may never have occasion to observe a second or subsequent long-term disability review procedure. However, the role insurance adjusters play in reviewing claims to identify reasons for denial does also apply to what happens during an LTD claim review.
How Do You Prepare for Long-Term Disability Review Procedures?
In many respects, what happens during an LTD claim review is very similar to the requirements and steps involved in the initial review of a submitted claim. Staying current with the same types of documentation you submitted in support of your original claim can set you up for success during the review process for long-term disability claims. Keep accurate, up-to-date records of all your medical procedures, diagnostics, and any prescribed treatments. As important as it is to collect medical evidence directly from the healthcare providers involved in the management and treatment of your condition, make it a point to keep timely notes of your own. Create a record of your symptoms, your attempts at recovery, and your day-to-day challenges as they develop in real-time. Understanding LTD claim review processes prepares you to familiarize yourself with your policy’s terms, particularly any circumstances that allow for the termination of benefits, and organize your medical evidence to demonstrate that your condition still meets the policy’s definition of disability so that you are ready to submit comprehensive, carefully-presented information when long-term disability review procedures call for it.
Final Thoughts: Staying Prepared for LTD Claim Reviews
Understanding the review process for long-term disability claims is essential for protecting your benefits over time. While securing initial approval can feel like a major hurdle, periodic reviews remain a routine and often rigorous part of maintaining eligibility. Whether your long-term disability review procedure is a scheduled renewal or an audit initiated by your insurer, the outcome often hinges on how well you can document the continued impact of your condition. Missing deadlines, submitting incomplete documentation, or failing to meet shifting policy requirements can all lead to LTD benefits being reduced—reasons and actions for which will be detailed by the insurer and difficult to challenge after the fact. By staying organized, consistently updating your medical records, and understanding your policy’s definition of disability, you place yourself in the strongest possible position to navigate each stage of the review process confidently and successfully.
