Long-Term Disability Insurance Attorneys
Available Nationwide to Get You the Help You Need
Long-term disability insurance pays a monthly disability benefit if you become sick or injured and cannot work. The majority of people who have disability insurance get their long-term disability policy from work. A federal statute known as ERISA, the Employee Retirement Income Security Act, is the law that applies to the majority of long-term disability claims.
When you have a claim for long-term disability benefits, the disability insurance company will want your medical records and ask that you complete disability forms or provide other information. Your doctors will also be asked to complete a form known as an Attending Physician Statement (APS). You may also be sent for a medical examination by the disability insurance company’s doctor and surveillance might be done to check your activity levels.
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Eligibility for Disability Benefits
Generally, an employee has both short-term disability (STD) benefits and long-term disability (LTD) benefits from work. Short-term disability policies usually pay a disability benefit for 26 weeks. Long-term disability may be available to those who are still cannot go back to work because of a medical condition. Long-term disability begins after short-term disability benefits have been exhausted.
Disability insurance covers all types of medical conditions, such as:
- Chronic back pain
- Fibromyalgia
- Lupus
- Chronic fatigue syndrome or “CFS”
- Strokes
- Heart attacks
- Carpal tunnel syndrome
- Multiple sclerosis or “MS”
- Diabetic neuropathy
- Radiculopathy
- RSD or CRPS
- Mental health conditions
Some disability policies limit the maximum amount of months that disability benefits are paid for certain medical conditions, such as CFS and fibromyalgia.
Understanding Your Disability Insurance Policy
It is important to understand the terms of your disability insurance policy if you have a disability claim. The typical long-term disability policy defines disability to mean you are unable to work in your “own occupation” for the first 24 months. After 24 months, you have to prove you are disabled from working in “any occupation.” The majority of disability benefits that are terminated by disability insurance companies occur around this time.
Many disability policies also limit payment of disability benefits due to a mental health condition to 24 months. This is called a mental health limitation. Depression, anxiety, bipolar disorder, and PTSD are some of the mental health conditions that have this limited payment period. Insurance companies sometimes ignore that there is also a physical condition that causes the person not to be able to work in order to limit the time during which someone can receive disability benefits.
What Is the Difference Between Group & Individual Disability Insurance?
Put simply, group disability insurance is a type of disability insurance offered by an employer to the company’s employees, whereas individual disability insurance is a form of insurance that is purchased by a single individual. Individual disability insurance can be purchased when an employer does not offer group insurance or when the offered group insurance is not sufficient. In the latter instance, individual disability insurance can be supplemental to group insurance.
Some of the benefits of group disability insurance include:
- It is typically available to all employees, regardless of whether or not they have pre-existing conditions
- It is often more affordable than individual disability insurance and has lower premiums
- It is convenient for employees
Meanwhile, some of the benefits of individual disability insurance include:
- It generally offers more extensive coverage than group disability insurance
- Employees retain coverage when they leave their job or are let go
- Individual insurance plans can be customized to each policy holder
Can I Purchase Long-Term Disability Insurance on My Own, or Does It Need to Be Employer-Provided?
You can purchase long-term disability insurance on your own, in addition to or instead of any employer-provided coverage. Individual policies are available through insurance agents or brokers and can be tailored to your specific needs. While employer-provided policies are often convenient and may offer group rates, purchasing your own policy can provide more flexibility and control over the coverage terms. If you have access to both types of insurance, it’s important to understand how they interact and how benefits from one might affect the other.
What Does Total Disability Mean?
Under ERISA law, the ability to work in Any Occupation requires sitting at least 6 hours in total out of an 8-hour workday. That includes breaks as needed. The remaining 2 hours require the ability to walk or stand. There are other requirements under ERISA, but sitting for 6 hours is the most important when dealing with an Any Occupation disability claim review.
Any occupation does not mean any job whatsoever. The insurance company must take into consideration your past training, education, and experience when evaluating whether there is another occupation in which you can actually work.
The insurance company will conduct a review of your medical records or examinations by their doctors. Then based on that review, they may do a vocational review or transferable skills assessment to identify other potential jobs they believe you could perform.
Disability benefits claims are reviewed periodically and disability benefits can be terminated at any time. However, most long-term disability benefits are terminated because of the “Any Occupation review.”
For this reason, it is important to speak with your doctors ahead of time so they are aware the standard for disability has changed. You will want to make sure your doctors understand that you are now required to be disabled from any occupation.
How Do I Qualify for Long-Term Disability Insurance Benefits?
To qualify for long-term disability insurance benefits, you must meet the policy's definition of disability, which usually involves proving that you are unable to perform the duties of your current job or any other job for which you are reasonably qualified. The insurance company will assess your medical condition, work history, and sometimes even your ability to perform alternative work. You typically need to provide thorough medical documentation and possibly undergo assessments or reviews by the insurer’s medical professionals to support your claim.
How Long Do Long-Term Disability Insurance Benefits Last?
The duration of long-term disability insurance benefits depends on the specific terms of your policy. Some policies provide benefits for a set number of years, such as 5 or 10 years, while others may continue until you reach retirement age, typically 65.
The length of time you can receive benefits often depends on the severity of your disability and the terms outlined in your insurance contract. It's important to review your policy carefully to understand the duration and any conditions that might affect your benefits.
Are There Any Exclusions or Limitations in Long-Term Disability Insurance Policies?
Yes, long-term disability insurance policies often come with exclusions and limitations. Common exclusions might include pre-existing conditions (medical issues you had before obtaining the policy), certain types of disabilities like those resulting from self-inflicted injuries, or disabilities caused by drug or alcohol abuse.
Policies may also have limitations on the types of occupations covered, or they might reduce benefits if you can perform some level of work or if you receive other sources of income. It’s crucial to read the policy details carefully to understand what is and isn’t covered.
How Can I File a Claim for Long-Term Disability Insurance?
To file a claim for long-term disability insurance, you should start by reviewing your policy to understand the required documentation and process. Typically, you will need to complete a claim form provided by your insurance company and submit it along with detailed medical records and other supporting documents that verify your disability. It may also be necessary to provide information about your employment and income.
Following the insurer’s instructions precisely and keeping copies of all correspondence can help ensure a smooth claims process. If your claim is denied, you have the right to appeal the decision and should consider seeking assistance from a legal or insurance professional if needed.
What to Do if My Disability Benefits Have Been Denied
If you have been denied disability benefits, it's crucial to take the appropriate steps to protect your rights and pursue the benefits you deserve. Here's a guide on what to do next:
Filing an Appeal
The first course of action in an ERISA disability benefits claim is to file an appeal. Typically, after receiving a denial or termination, you have 180 days to submit your appeal. This is a critical opportunity to present additional evidence in support of your claim.
During the appeal process, you need to address and challenge the reasons provided by the disability insurance company for their denial or termination. It's essential to include all relevant medical records and any supportive information from your doctors that strengthen your case.
Working with an experienced long-term disability insurance attorney can greatly assist in determining the most compelling evidence to include in your appeal. They can also identify any potential violations or irregularities in the disability insurance company's handling of your claim.
If Your Appeal is Denied
In the event that your appeal is denied, you may have the option to pursue a second appeal. However, it is more likely that your next step will involve filing a lawsuit in federal court. It is highly recommended to engage the services of an attorney during this stage, as federal ERISA litigation involves intricate rules that must be strictly followed. Even a minor mistake could jeopardize your claim.
Having an attorney by your side provides several advantages. They will have a comprehensive understanding of the complex federal ERISA laws, ensuring that your case is properly presented and argued. They will work diligently to protect your rights, gather additional evidence if necessary, and navigate the legal procedures skillfully.
By enlisting the support of a knowledgeable ERISA attorney, you enhance your chances of securing the disability benefits you rightfully deserve.
Get Help Identifying Your Options
ERISA gives certain rights to people who have disability claims. ERISA also gives many advantages to disability insurance companies. The long-term disability lawyers in our firm are experienced with disability insurance claims and ERISA.
Our lawyers can help with the initial disability claim, appeal a denied disability claim, and file a lawsuit for disability benefits. Dabdoub Law Firm is proud to help people nationwide.
Call our lawyers today at (800) 969-0488 for a free case evaluation. Our long-term disability lawyers do everything in our power to get our clients the help they need!
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