Long Term Disability is Different than Social Security Disability
Long term disability is coverage usually provided by your employer as a benefit of your employment. In order to receive long term disability, you don't have to be hurt at work, but you do have to qualify as disabled under the policy your employer purchased.
If you are working for a private employer, a federal law (ERISA, which stands for the Employee Retirement Income Security Act) governs your claim for long term disability.
You can also purchase a private long term disability insurance policy on your own.
If you have a long term disability policy or your employer provides long term disability insurance, there are several steps to take to receive benefits if you can't work because of a medical condition or an injury.
A successful claim for long term disability starts with analyzing your policy.
Your long term disability insurance policy has terms, conditions and definitions that govern your claim for benefits. It is critical to understand your specific policy - the major disability insurance companies, Hartford, Guardian, Mutual of Omaha, etc. have similar policy provisions, but each insurance company policy is a little different.
- Are there medical conditions that are excluded from the policy?
- Are there limits on the time you can receive benefits for certain medical conditions?
- How does the policy define your job and job duties?
- Are there set offs or reductions in the amount of benefits you receive if you also receive another benefit for the same injury or illness, like workers compensation, a car accident settlement or social security disability?
- If the injury was caused by someone else or happened at work, do you need to pursue that case if you receive long term disability benefits?
Educating your doctor about long term disability is important.
We work with physicians all the time as expert witnesses and consultants for people we help after a serious injury or illness. Let's face it, doctors - especially treating doctors - are busy. Many of them barely have time to exam or talk to you, much less fill out paperwork for an insurance company.
And remember, your long term disability policy can have a different definition of disabled than your doctor. He may fully support you and believe that you are 100% disabled and should not work. But how do you make sure he says that in a way that satisfies the insurance company?
We've published tips on talking to your doctor about disability - and one of the keys is getting a meeting to explain the parameters of your long term disability insurance plan, to make sure his reports and medical records will satisfy the insurance company.
If your long term disability claim is denied, get an experienced lawyer to appeal.
Long term disability insurance companies deny legitimate claims because they know that only a percentage of people (who are legitimately disabled due an injury or medical condition) will appeal, so they automatically save money on those who don't.
And unfortunately, in long term disability claims, filing a successful appeal without an attorney is extremely difficult.
There is an entire process to filing a strong appeal, and it is your one chance. Yes, after losing an appeal, you can file a lawsuit against the insurance company to get the benefits you deserve, but the federal judge who decides your case will only consider the evidence provided to the insurance company as part of your appeal.
You don't get a second chance to add evidence - you have to get it right during the appeal stage. And under ERISA, you only have 180 days to appeal after you receive the letter denying benefits.
If you need help with long term disability or have questions about your claim, call us today at (202) 393-3320. We offer video meetings and consultations and if you received a letter denying your long term disability benefits, we'll review that for free and give you a confidential plan for your appeal.