What Affects the Duration of a Disability Claim?

When a worker files a disability claim, it sets off a chain of decisions, timelines, and responsibilities that result in a swift, safe return to work or extend the claim beyond medical necessity. The nuances of disability duration might seem trivial but are essential to controlling costs, reducing fraud risk, and improving outcomes for injured workers.

In this blog, we’ll break down what determines the duration of disability claims, and how employers and insurers can intervene early to prevent claims from spiraling out of control.

What Is Disability Duration?

Disability duration refers to the period during which an injured or ill worker is considered unable to perform their job duties. For insurers and employers, it’s a key metric that reflects both claim cost and employee well-being. While each case is different, standardized benchmarks exist based on diagnosis, occupation, and age, helping you determine whether a claim’s length is in line with expectations—or showing signs of trouble.

Essentially, the longer a claim remains open, the more it costs, and not just in payments, but in lost productivity, administrative time, and potential legal exposure. In fact, research shows that the likelihood of an employee returning to work drops sharply the longer they are out of work, particularly after the 12-week mark according to ACOEM (Work Disability: A Prevention and Management Guide.)

Short-Term vs. Long-Term Disability Claims

Short-term disability (STD) typically covers injuries or illnesses that last a few weeks to several months. Long-term disability (LTD) involves more severe medical conditions and often overlaps with Workers’ Compensation claims when the cause is job-related.

From an adjuster’s perspective, STD claims should resolve predictably. If they don’t, it’s often a sign that the injury isn’t healing as expected or that psychosocial factors are at play. LTD claims, while often legitimate, require more intensive oversight, coordination with medical providers, and regular reassessment.

What Affects the Duration of a Disability Claim?

Many factors can lengthen a disability claim, including:

Nature of the injury – A broken wrist and a herniated disc are both painful, but vastly different in terms of recovery time.

Job demands – Sedentary work may allow earlier return than physically demanding roles.

Comorbidities – Diabetes, obesity, or mental health issues can complicate even routine recovery.

Psychological factors – Fear of reinjury, lack of support, or anxiety can unknowingly extend disability.

Workplace dynamics – If a worker feels unwelcome or unsafe returning, they’re more likely to stay out.

Data from the Integrated Benefits Institute (IBI) confirms that mental health plays an outsized role in long-term disability. Conditions like depression can not only extend recovery from physical injuries but also independently qualify as disabling illnesses.

Disability Claim Red Flags

It’s crucial to keep an eye out for subtle cues that suggest a claim may not be progressing as expected. Red flags include:

• Vague or changing symptoms without clinical backing
• Inconsistency between diagnosis and disability timeline
• Missed medical appointments or lack of active treatment
• Secondary gain behaviors (e.g., legal action, financial stressors)
• Resistance to transitional duty or return-to-work offers

Each of these signs doesn’t necessarily point to fraud—but they do signal that a closer look might be needed. That might mean requesting an independent medical exam (IME), engaging a nurse case manager, or initiating a more proactive return-to-work plan.

Leading insurers use evidence-based disability duration guidelines (like those from MDGuidelines or ODG by MCG Health) to evaluate claims. These tools take into account millions of historical cases and medical research to estimate how long a condition should reasonably prevent someone from working.

By comparing real-time claims to these benchmarks, you can spot outliers early. This allows for timely interventions, whether it’s a clinical review, treatment modification, or support to overcome psychosocial barriers.

Return-to-Work: The Key to Shorter Claims

Return-to-work (RTW) programs are proven to reduce claim duration and cost. The most effective programs require a collaborative approach, that involves HR, the treating physician, the injured worker, and the insurer.

Light-duty assignments or transitional work can keep the employee connected and motivated while recovering. These programs not only support healing but also reduce the risk of long-term disability by preserving the worker’s routine and sense of purpose.

According to the WorkCompCentral Special Report, companies that implement structured RTW programs see up to 50% shorter claim durations and improved long-term outcomes.

Disability duration isn’t just a number—it’s a window into how effectively a claim is being managed. By understanding what drives it, Work Comp professionals can prevent unnecessary extensions, control claim costs, and support the recovery of their injured workers. The challenge isn’t just medical—it’s operational, ethical, and human.

Learn more about how to assist your disability claims in making the best, fastest progress possible right here.

Check out our sources:

Integrated Benefits Institute. “Health and Productivity Impact of Chronic Conditions.” IBI, www.ibiweb.org.

American College of Occupational and Environmental Medicine. Work Disability Prevention and Management Guide. ACOEM, 2021.

MCG Health. “ODG by MCG Guidelines.” www.mcg.com.