At the end of the day, your relationship with your insurance company is based on contractual obligations. If you become disabled pursuant to the definition of your insurance policy, your insurance company is required to pay out long-term disability benefits. However, this obligation cuts both ways and your insurance policy most likely has strict timelines in which you need to file your application for long-term disability benefits. While these timelines can differ depending on the insurer and the terms of the policy, failure to file your claim for long-term disability benefits on time can result in a denial of what would otherwise be a legitimate claim.
Unfortunately, not every application for long-term disability is made on time, for a variety of reasons. This leads to the question of whether you can file your long-term disability later than the time period for furnishing proof of a disability that is specified in the policy. The answer, as with most legal questions, is: maybe.
What Happens if I File My Long-Term Disability Claim Late?
Generally speaking, insurance companies strictly follow the terms of any contract or policy to which they are a party and expect the same from anyone who seeks to benefit from such a contract or policy, and meeting the timelines laid out in the contract for filing your claim is one such term.
The consequences of filing your long-term disability claim late will vary depending on the specifics of your circumstances and the specific wording of your policy, however the most common consequences are:
- Denial of your claim for benefits: the most severe consequence for missing a deadline for filing your long-term disability application could be the automatic rejection of your application due to failure to adhere to the terms of your policy
- Loss of Benefits: Depending on the terms of your policy and how late your filing is, you could lose out on payment of benefits you otherwise would have been entitled to.
- Higher Burden of Proof: A late filing of your long-term disability application could result in the requirement to provide further documentation, either to better explain the delay or due to the insurance company looking closer at your claim which can drag out the process and complicate your claim needlessly.
- Impact your Right to Appeal: Depending on the specific terms of your policy a late filing of your long-term disability application could impact your right to exercise certain rights under appeal should your application be denied.
Reasons Why an Insurance Company Might Grant Exceptions to Late Filing
Insurance companies have been known to accept late filings of long-term disability claims in certain circumstances. Circumstances and fact patterns that can lead to an insurance company agreeing to allow for late filing can include:
- Lack of Knowledge: If you were unaware of your rights or the requirements surrounding making an application for long-term disability, this could be considered a valid reason for late filing. This scenario is often seen in the context of group coverage policies through work, where employees may not have access to the insurance policy, or be aware they have access.
- Disability-Caused Restrictions: If you were unable to file your claim for long-term disability due to the severity of your symptoms and/or condition, this could be a valid reason for late filing of your application. Medical records would be required as evidence of the symptoms and/or condition.
- Delays by the Insurer: If the reason you filed late were due to delays or misunderstandings caused by the insurance company, for example if an insurance company representative takes too long getting back to you and you miss a deadline, or if they were to misrepresent something to you.
These are simply some examples of when an insurance company may agree to allow you to file your long-term disability benefits application and there is no set rule as to when an insurer will or won’t agree to a late filing.
Equitable Remedies for Late Filing of Your Long-Term Disability Claim
While insurance companies can agree to allow late filing of applications for long-term disability benefits in certain circumstances, they do not have to. Insurance companies are well within their rights to demand that their insureds comply with their contractual obligations.
If your long-term disability claim was denied for late filing of your initial submissions, there is still hope by way of the equitable remedy known as “relief from forfeiture”. Relief from forfeiture occurs when a Court excuses an insured from strict compliance with the terms of an insurance policy if enforcing full compliance would result in a harsh penalty to the insured and cause no significant prejudice to the insurance company. In order to benefit from relief from forfeiture, generally there needs to be imperfect compliance with the contractual terms of the policy. Complete non-compliance will usually not result in an Order for relief from forfeiture.
Experienced Insurance Denial Lawyers
If you have a problem with an application for long-term disability benefits which were filed late, contact the experienced insurance denial lawyers at Taylor & Blair LLP today to schedule a free consultation.