How Long Do I Have to Formally File My Claim?

You have finally come to the realization that working through the pain and limitations of your disability is no longer in your best interests.  Continuing to work is not an option for you, so you have decided to make a long term disability insurance claim.  How long do you have to file your claim?  Does it have to be on the day that you become disabled, or can it happen a couple months down the road?  The answer to that question is: it depends.

Insurance companies will try and exploit every option available to deny a claim for disability insurance benefits.  One method they utilize is to put strict requirements on how and when an insured must give notice to the company of their disability and what that notice must contain.

The first place to start looking to determine your insurance company’s requirements is the insurance policy itself.  Look through the policy index or headings for a section similar to “Notice of Claim.”  This section lets you know how much time is available to file a disability claim with the company.Most courts have strictly enforced these specific requirements.  For instance, in Grenell v. UPS Health and Welfare Package,[1] the California court held that a claim was untimely when filed outside of the plan’s thirty day reporting requirement from the initial date of disability, and was thus properly denied.  In another case, Craig v United States Health & Acci. Ins. Co.,[2] the court upheld the denial of benefits when notice of sickness wasn’t given within the 10 days required by the policy.  Similarly, in Doe v. Cigna Life Ins. Co. of New York,[3] the court upheld the denial of insurance benefits where notice of claim did not properly describe the nature and extent of disability as required by the insurance policy.

Some people wonder what the phrase “as soon as reasonably possible” means.  Maryland’s supreme court, in Maryland Casualty Co. v Ohle,[4] interpreted “as soon as may be reasonably possible” to mean a reasonable time after the accident occurs, under the facts and circumstances of the particular case.  Most courts subscribe to a similar definition of this phrase. In Lyon v Railway Passenger Assur. Co.,[5] the Iowa supreme court held that satisfactory notice had to be given with due diligence under the circumstances of the case, and without unnecessary and unreasonable delay.  In that case, when notice of disability was given 3 weeks after the accident, the court interpreted the “immediate notice” policy requirement to include notices given “as soon as reasonably possible,” because during the three weeks of recovery the insured was “ not able to do anything.”   Likewise, in Lehmann v. UNUM Life Ins. Co. of America,[6] the Wisconsin court held that where an insurance policy required notice within 90 days, a notice by the plaintiff to the insurance company 14 months after a cancer diagnosis did not warrant the bestowal of benefits under the “as soon as reasonably possible” clause of the policy, when unaccompanied by a sufficient reason for the delay.

However, these examples don’t mean that an insured can never file a disability claim outside the specific time period stated in the policy.  For example, a former client was paralyzed in an accident and recovered in the hospital for two to three months.  In her case, her filing window was much larger as she had a legitimate reason for not being able to file a claim for disability benefits.  Most people would agree that it would be unreasonable for the insurance company to require her to file the claim while paralyzed in the hospital.  Thus it was reasonable for her to file her claim months following the onset of his disability, after the hospital discharged her.

Most disability claimants need to follow the 20 to 60 day deadlines established by their disability insurance policies, and generally shouldn’t wait too long before filing their claim.  That being said, claimants should also not file a disability claim without being properly prepared for the documentation and evidence requirements associated with filing a claim.  Claimants will need to have ready, among other things, documentation of their disability and diagnosis by a doctor, and must be prepared to share that information with their insurer.

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[1]Grenell v. UPS Health and Welfare Package, 390 F.Supp.2d 932 (C.D.Cal., 2005).

[2] Craig v United States Health & Acci. Ins. Co., 80 SC 151 (1908).

[3] Doe v. Cigna Life Ins. Co. of New York, 304 F.Supp.2d 477 (W.D.N.Y., 2004).

[4] Maryland Casualty Co. v Ohle, 120 Md 371 (1913).

[5] Lyon v Railway Passenger Assur. Co., 46 Iowa 631 (1877).

[6] Lehmann v. UNUM Life Ins. Co. of America, 916 F.Supp. 897 (E.D.Wis., 1996).