Why Is My Long-Term Disability Claim Taking So Long?

Waiting for a decision on a long-term disability (LTD) claim can be stressful — especially when you are dealing with a serious health condition and counting on that income. Unfortunately, delays are common in the LTD claims process, and they happen for a wide range of reasons. Some are routine; others may signal a problem with how your claim is being handled. Understanding what is driving the delay in your case can help you take the right steps to protect your rights.

What Are the Typical Timelines for Long-Term Disability Claim Decisions?

The timeline for an LTD claim decision depends largely on whether your policy is governed by the Employee Retirement Income Security Act (ERISA) or is a private, individual policy. Most employer-sponsored group disability plans fall under ERISA, which sets specific deadlines that insurers must follow.

How Long Does an Insurer Have to Decide My Claim Under ERISA?

Under ERISA regulations, an insurance company has 45 days from the date it receives your claim to make an initial decision. However, the insurer may extend that period by up to 30 days if it needs more time, and it can take a second 30-day extension if necessary. In total, an initial decision under ERISA can legally take up to 105 days.

During any extension period, the insurer is required to notify you in writing and explain the reason for the delay. If you do not receive that notice, the extension may not be valid. It may also not be valid if the insurer has not articulated a permissible reason for the extension.

What About Non-ERISA or Individual Disability Policies?

Individual disability insurance policies purchased outside of an employer plan are not subject to ERISA timelines. Instead, state insurance law governs the process, and deadlines vary. Many states require decisions within 30 to 45 days of receiving a completed claim, but the standards for what triggers that clock, and the penalties for missing it, differ significantly from state to state.

When Does the Timeline Clock Actually Start?

Under ERISA, the timeline clock starts when the claims administrator receives the claim. However, often insurers take the position that the deadline does not necessarily start on the day you submit your claim. Rather, it begins once the insurer deems the claim “complete,” meaning it has received all the forms, medical records, and other documentation it considers necessary. Insurers will routinely stagger requests for information in the hopes of effectively pausing or resetting this clock, which is one reason delays are so common.

How Do Internal Reviews and Third-Party Evaluations Extend Processing Time?

Even within the timeframes ERISA allows, insurers have significant flexibility in how they gather and evaluate information. Several review processes can substantially extend the time before you receive a decision.

What Is an Independent Medical Examination (IME), and How Long Does It Take?

An IME is a medical examination arranged and paid for by the insurance company and usually conducted by a physician of the insurer’s choosing. Despite the word “independent,” these examiners are retained by the insurer. Scheduling an IME can take several weeks, and the review of the examiner’s report adds more time on top of that.

Attending an IME is usually required under the terms of your policy, and refusing to cooperate can jeopardize your claim. However, you have rights during this process, including the right to know who will be examining you and what specialty they hold.

What Role Do Functional Capacity Evaluations (FCEs) and Vocational Assessments Play?

Insurers may order Functional Capacity Evaluations (FCEs) to assess your physical abilities, or vocational assessments to determine whether you can perform your own occupation or any occupation. You may also want to arrange for your own FCE or vocational assessment. Both types of evaluations require scheduling, travel, and subsequent report preparation. When multiple evaluations are ordered in sequence, weeks can easily turn into months.

In cases involving cognitive or psychiatric conditions, neuropsychological evaluations may also be required. These are often multi-day assessments and come with lengthy reporting timelines.

How Does Internal Peer Review Add to the Timeline?

Before issuing a decision, many insurers route claims through one or more internal physician reviewers or nurse case managers. These reviewers assess the medical evidence without ever examining you. The review process itself, combined with any back-and-forth with your treating physicians for clarification, can add several more weeks to the clock.

What Common Administrative or Documentation Issues Cause Delays?

Beyond formal evaluations, a range of administrative factors can slow a claim to a crawl. Some are within your control; others are not.

What If My Medical Records Are Incomplete or Inconsistent?

Incomplete medical records are one of the most common causes of delay. If your treating physician has not consistently documented your symptoms, functional limitations, and treatment history, the insurer may have grounds to request additional records or ask for clarification. Gaps in treatment — even those caused by circumstances outside your control, such as insurance lapses or provider availability — can raise questions that the insurer will use to justify further review. When preparing to file your claim, it is best to order your full set of records so you can help avoid delay and correct any misinformation found in your records.

What Happens If the Insurer Keeps Requesting More Documentation?

Insurers are permitted to request additional information, but repeated documentation requests — especially when the information requested overlaps with what you have already provided — can be a sign of claim-handling problems rather than a legitimate administrative need. Insurers attempt to reset or pause the decision timeline by asserting more requests for records, effectively allowing the insurer to delay indefinitely if the requests are not managed carefully.

Keeping a detailed record of every document you submit, along with the date submitted and the method of delivery, is important for protecting your rights if a dispute arises later.

Can My Employer or the Plan Administrator Contribute to Delays?

Yes. LTD claims under ERISA involve multiple parties: you, your insurance company, and often your employer or the plan administrator. Delays in obtaining the plan documents, employer statements, or payroll records that insurers sometimes require can add time that is technically outside the insurer’s own review period. Coordinating between all parties takes time, and breakdowns in communication are common.

Does Coordination with SSDI Claims Affect the Timeline?

Many LTD policies require claimants to apply for Social Security Disability Insurance (SSDI) and allow the insurer to offset LTD benefits by the SSDI entitlement or award amount. It can take years to get to an administrative law judge to hear your case if the Social Security Administration initially denies your claim. If that is the case, the LTD carrier will often have to decide your LTD claim without the benefit of an SSDI approval. An insurance company typically cannot wait for an SSDI decision to decide your claim but in some circumstances, LTD plans will tie eligibility to the SSA’s decision, which can cause significant delays.

When Does a Delay Signal a Deeper Problem with Your Claim?

Not every delay is routine. Some patterns in how an insurer handles a claim — or fails to handle it — suggest that the delay itself may be part of a strategy to pressure claimants into abandoning their claims or accepting lowball settlements.

What Are the Warning Signs That a Delay Is Not Normal?

Pay attention to the following patterns:

• You are not receiving written notices explaining the reason for extensions or the information still needed.
• The insurer is requesting records or evaluations that appear duplicative of what you have already provided.
• The insurer’s representatives are difficult to reach, and calls or written inquiries go unanswered.
• You have received informal communications suggesting your claim is under review, but no formal decision or extension notice has been issued.
• The delay has extended well beyond the ERISA deadline of 105 days without a clear explanation.

Can an Insurer Be Held Accountable for Bad Faith Delays?

Under ERISA, the remedies available for insurer misconduct are more limited than under state insurance bad faith laws. If an insurer has delayed a decision without sufficient justification, you can file a lawsuit on the basis of your claim being “deemed exhausted.” Federal courts can award benefits due, interest, and attorney’s fees in appropriate cases. For non-ERISA policies, state bad faith statutes may provide broader remedies, including damages beyond the policy benefits themselves.

The key is building a clear record of the insurer’s conduct throughout the delay — including all correspondence, all documentation requests, and all deadlines that were missed or extended.

At What Point Should I Consult an Attorney?

You do not need to wait until your claim is denied to speak with a disability attorney. If your claim has been pending for an unusually long time, if you are receiving repeated documentation requests that seem unreasonable, or if you simply are not getting clear answers from the insurer, consulting with an ERISA disability attorney early can help you understand your rights and avoid missteps that could affect your claim down the road.

An attorney familiar with ERISA claims can review your correspondence, assess whether the insurer’s conduct is within normal bounds, and advise you on how to respond to documentation requests in a way that protects the administrative record — which becomes critically important if your claim is later denied and you need to appeal.

Have Questions About Your Long-Term Disability Claim?

If your claim has been delayed and you are not sure what to make of it, Roberts Disability Law is available to help you understand where things stand. Our practice focuses exclusively on ERISA disability claims, and we are familiar with the tactics insurers use to slow the process. Reach out through our Contact Us page to learn more about your options.