If you’re unable to work due to a serious illness, injury, or medical condition, you might be eligible for benefits from a long-term-disability plan.
Below, Jonathan M. Feigenbaum, Esquire
explains the basics of a long-term-disability application
What Are Long Term Disability Benefits?
Long-term-disability (LTD) insurance is different than Social Security disability. LTD isn’t a public benefit. Instead, these plans are sold by insurance companies, or sometimes self-funded by employers, and offer certain benefits if the insured becomes disabled. Both employers and individuals can buy long term disability insurance policies. Individual disability insurance policies purchases through an insurance agent are very different compared with LTD benefits offered by a private sector employer. LTD plans provided by a private sector are governed under the Employee Retirement Income Security Act of 1974 (ERISA). This is the federal law that governs all employee benefits for private sector employees. Government employees and those working for most religious entities are exempt from ERISA.
What Are the Requirements?
LTD policies are not all the same. You should carefully review the terms of your plan. However, there are some common requirements. You:
- Must typically wait for a period before you can file for long term disability benefits (you might receive short term disability benefits during this time). Often the waiting period is 90 days or 180 days.
- Must prove that your disability prevents you from doing the material and substantial duties of your current occupation, and then typically after 2 years, the duties of any occupation based on your education, training or experience.
- Cannot be barred from coverage due to exclusions, such as pre-existing conditions when you file a claim in the first 12 months of coverage.
- Must file your claim timely.
Even a single, honest mistake can result in a denial of benefits
Step 1: Get Organized
Before you file your long-term-disability claim, you should compile your evidence, review your plan documents, and understand its procedures. If you file your claim too early — or too late — the insurance company may deny it. You should also review the LTD policy’s terms and exclusions. If you need help getting copies of your LTD plan documents, contact a human resources representative, your insurance agent, or a long term disability lawyer.
Once you have reviewed (and understand) your LTD plan’s policies and procedures, start building your claim. Request a copy of the LTD application and compile any evidence that supports your claim for disability. This might include medical records, doctors’ statements, and other important information.
Step 2: Complete and Submit Your Statement
A long-term-disability application typically has multiple parts. You must complete a statement that sets out information about your identity, employment history, medical conditions, treatment, and your disability. It’s important that you provide honest and accurate information on this form. You’ll also need to sign several medical releases.
While the insurance company will ask for the bare minimum of information, make sure your application is detailed. Don’t be afraid to attach additional pages explaining your disability and medical conditions. You can also submit medical records and other evidence. You must be proactive. Don’t expect the insurance company to provide material assistance to you.
Step 3: Make Sure Your Employer and Doctor Does Their Part
Your employer and doctor will also have to complete a series of forms. If the insurance company doesn’t receive them in a timely manner, it will probably deny your claim. While most employers and doctors take their obligation to complete and submit LTD forms seriously, you should always follow up and confirm that they did their part.
Step 4: Keep Copies of Everything
Unfortunately, many long term disability claims are denied. While we always hope for the best, you should prepare for an appeal. Keep copies of everything you send to the LTD company — and everything you get from them. This information can help your attorney understand your claim and build an effective appeal strategy.
Step 5: Consider Working With a Long-Term- Disability Lawyer
Most long term disability insurers are for-profit companies. While their adjusters might seem pleasant and their marketing materials might feel warm and fuzzy, it’s in their financial interests to deny your claim. Most worthy claimants receive payment, but not all. When you work with an experienced LTD lawyer, you give yourself the best possible chance of delivering a successful application. Your lawyer will ensure that you properly complete your application, meet all of the company’s deadlines, and provide them with a compelling claim for disability.
And if your application is denied
, you should immediately contact a skilled ERISA or LTD lawyer. Mostlong- term disability appeals involve a two-step process — you cannot simply file a lawsuit in federal court or state court without filing an appeal to the insurance company first. An experienced long term disability attorney will help you comply with the appeal process and build a strong evidentiary record that supports your claim.
Speak to a Long Term Disability Lawyer
For more information or a personalized evaluation, contact
Jonathan M. Feigenbaum, Esquire today.