If You Need to File for Long Term Disability Because of An Injury or Illness, Get Started Now.
Many people have long term disability benefits as part of their employment in D.C. Most employers will get policies from the major long term disability carriers - Guardian, MetLife, Hartford and a number of other insurance companies offer these policies. If coverage is provided as an employment benefit through your job (your employer pays the premium), your long term disability insurance claim will be governed by a federal law known as ERISA (the Employee Retirement Security Act) and there are several things you need to know about your claim.
If you"ve had a serious injury or have a medical condition that prevents you from working, don't wait to get started with this process. You need to understand what you're getting in to here - and that starts with analyzing your disability insurance policy that will govern your claim and benefits.
Do you understand the terms, conditions and definitions of your long term disability policy?
So get a copy of that policy and make sure you understand the terms, conditions and definitions of the policy.
Every long term disability insurance policy from each of the major insurance companies is a bit different, but there are several things most of them have in common. The main thing to understand right away is how your specific policy defines disability, your occupation and the length of time it will pay you.
As an example, let's say you're a doctor or nurse working at an Intensive Care Unit of a hospital in Washington. D.C. and you hurt your neck lifting a patient who passed out and needed emergency care. The reflexive action of catching, holding and lifting that patient caused herniated discs in your neck. You have a long road of surgery and rehab ahead and won't be able to return to the demanding physical work of the ICU.
Your long term disability insurance policy could have a clause that excludes injuries at work (you could still receive workers compensation benefits in D.C. because the injury happened on the job).
But let's say there is no exclusion or the same injury happened at home - could you get long term disability benefits while you can't work?
You'll need to analyze that long term disability insurance policy again - how does it define your occupation? Is it truly your own occupation at the hospital you work at - all of the physically demanding activity of providing medical care in a busy urban ICU? Does the policy define your occupation as it exists in the national economy? Or does it define your occupation as essentially any physician?
Those definitions are critical because your injury or medical condition could prevent you from working in the ICU but not as a primary care doctor - you need to know what your policy says about that.
What do you need to do to prove you are disabled and can't work?
Plus, almost every long term disability policy has a discretionary clause that gives the insurance company discretion in determining whether you qualify for benefits. The only way to overcome this is to file an appeal with overwhelming evidence that you are entitled to benefits under the policy - we are not talking about filling out a form or sending in a letter that says you are appealing the denial of benefits.
We're talking about massive action to get the evidence needed to prove your injury or condition prevents you from working according to the terms of the policy, so the insurance company is forced to consider and evaluate medical and vocational evidence - and candidly, this would be really difficult to do on your own - most lawyers don't understand how and why this is needed.
Proving you're entitled to long term disability benefits can be difficult, and insurance companies know if you try to do it yourself, you probably won't be successful - how could you know the system you're now in and how can you be responsible for an appeal when you're seriously hurt or sick? Especially with so much at stake.
That's why we're here. Let us help you get started. If your claim for benefits was denied, we'll analyze your denial letter and outline the steps you should take in appealing that denial - that is a free, completely confidential service to get you started on the right path.
If you're thinking about applying for long term disability but have questions, we can talk through your specific situation by phone or video conference.
Just call us at 202-393-3320 to set up a video conference or phone call.
But don't wait - there are strict time limits in these cases (your have only 180 days to fie your appeal if you've been denied) and let's face it, everything has slowed down now, so may need more time and effort to get the evidence you need to prove you are entitled to long term disability benefits. Don't put it off - we have a lot of information to get you started.