If you were injured or have a serious medical condition that prevents you from working and have a long term disability policy provided through your employer or by a private insurer, you may be eligible for long term disability benefits.
Your employer may be providing an ERISA long term disability insurance plan through providers such as Hartford, MetLife, Mutual of Omaha, or Guardian, so you should have coverage for long term disability benefits should you ever need it. Note that long term disability insurance is different from short term disability as well as Social Security Disability Income benefits.
If you believe you qualify for long term disability according to the provisions outlined in your policy, making a claim for long term disability may be helpful on your road to recovery. If you’re not sure if you qualify, it never hurts to reach out to a us here at Donahoe Kearney to get more information, especially if you have already filed a claim and it's been denied.
Disability insurance companies require that you be able to prove you are disabled. But what does that mean?
Proving your disability is an important part of a disability claim. Having someone with experience dealing with insurance companies can be very helpful because they will know what the insurance companies are looking for under the terms of your policy.
In order to prove your disability, most insurance companies will require your treating healthcare provider to give his or her opinion stating that you are disabled - so you have to know how your disability insurance policy defines disability - do they use your actual job duties or a more general occupational description, usually put out by the Department of Labor? Here again, having someone with experience communicating with healthcare providers is very helpful when attempting to get a disability claim approved or appealing a denial of benefits. The insurance company will split hairs on your disability - if you are able to do even a part of your previous profession, they may deny your claim. If you don't present objective medical evidence, they may deny your claim. Our experience with insurance companies is that sometimes they just deny your claim on its face to see if you will fight the decision.
The big and critical difference between long term disability insurance plans and other types of insurance claims, such as car accidents, is that in car accident, work injury or medical malpractice cases, you have the opportunity for discovery if you have to file a lawsuit on the case, plus ample time to build the case, as well as appear in front of a judge or jury and make arguments. This is not true with long term disability insurance appeals - under ERISA you have only 180 days to appeal the denial, and if your appeal is denied, you must file a lawsuit in U.S. District Court (ERISA is a federal law). And there is no opportunity for discovery to add to or fix what you did not put in your appeal to the disability insurance company. A federal judge will decide your case based on what the insurance company had at the time it denied your appeal - this is also known as they administrative record, so it is critical to include everything in your appeal that can help your case.
If you can prove your disability and/or your healthcare provider indicates that you are disabled and cannot work, making a claim for long term disability may be helpful during your recovery. If you’re not sure whether your disability can be proven or if you don’t know how to talk to your healthcare provider about it, consider reaching out to us for more information.
If your disability claim has been denied, and it is governed by ERISA, don't wait to call us at 202-393-3320. You only have 180 days to appeal your case, and you really should not try to go it alone. We will review your denial letter for free, and give you our opinion on the next steps you should take. Send your denial letter to us - scan it, take a picture of it, fax it, or drop it off.
Donahoe Kearney, LLP
1901 Pennsylvania Avenue NW Ste. 900
Washington, DC 20006