Filing a Claim for Long Term Disability Benefits

As a lawyer helping people with long term disability cases, one of the first things I tell people is to get a copy of your long term disability policy.  Many Reading Your ERISA Long Term Disability Insurance Policypeople working for companies based in Washington, D.C. have long term disability coverage for injuries and medical conditions that prevent them from working, from their employer, as an employee benefit.

If you have a personal long term disability policy (a good idea) that you pay for, you should have received a copy of the policy when you paid the premium and got the coverage.

Either way, remember, you are now dealing not just with a serious injury, medical condition or disability that keeps you from working, you're now dealing with an insurance company like Mutual of Omaha, Guardian, Hartford and many others.

What Should You Look For in Your Long Term Disability Policy?

First, determine if the policy is covered by ERISA (that stands for the Employee Retirement Income and Security Act), a federal law that covers most long term disability policies provided as an employee benefit.

ERISA long term disability policies require several things you need to be aware of. 

There are filing and time limit provisions you need to pay attention to.  For example, if your claim is denied or your benefits terminated, you will receive a Denial Letter from the long term disability insurance company telling you why they denied your claim or decided that you are no longer disabled and cut off your disability benefits.

You have 180 days after receiving the denial letter to file an appeal. 

Appealing a long term disability denial is a major undertaking and you should talk to a disability lawyer about this.

The reason your appeal is complex and time consuming - even though you are legitimately disabled and can't work because of an injury, illness or medical condition - is because the appeal you research, draft and file with the disability insurance company will be a major component of the administrative record in your case.

It's important to build the record in your case because if the appeal is denied by the insurance company, your next step in an ERISA disability case, is to file a lawsuit in federal court.  Since ERISA is a federal law, a United States District Court is the place to file it.

Unlike in most cases, you won't get discovery to try to prove your case, or a jury trial.

Instead, a federal judge will decide your case based on the record.  And the judge's only decision may be whether the insurance company denial was "reasonable."

That's why your appeal is a critical stage - we have an entire appeal process that involves working with your physicians, outside medical consultants, specialists and testing, personal statement interviews and a lot more.

Pay Attention to the Terms and Definitions in Your Long Term Disability Policy.

Most long term disability policies have a number of exclusions and limitations. For example, most policies limit benefits for mental illness to 24 months.  If you have an autoimmune disorder that is getting worse and prevents you from working and many other activities you used to love, naturally, you may be depressed.  But be careful how that is characterized in your medical records and doctor's reports - situational depression is not the reason you are disabled, your autoimmune disorder is - the depression is simply a consequence of another medical condition.  Don't give the disability insurance company any ammunition to limit your benefits to 24 months.

Determine how your disability policy defines your occupation.  In many long term disability insurance policies, benefits are provided for a certain time if you cannot perform one or more material duties of your own occupation.  But that could be defined not as your specific job or position with your company, but a general description of your occupation, usually defined by the Department of Labor.

And it may be that after a time, your policy requires not that you are disabled from your own occupation, but that your injury or medical condition prevents you from working in any occupation.  This is a common way for disability insurance companies to deny your claim and terminate benefits, so know when that will likely happen and plan to prove your illness or injury prevents you from working in other occupations you might otherwise be qualified for.

Get the Right Legal Advice on Your Long Term Disability Claim

The best long term disability attorney for you will give it to you straight and try to help you no matter where you are in the process - whether you have a medical condition that is getting worse, are just applying for long term disability, or have been denied or your benefits terminated.

We work with people with serious injuries, illnesses and medical conditions no matter where they are in the long term disability process.

Reach out to us at (202) 393 - 3320 or complete the contact form and we'll call or email you to set up a time to talk about what you need. 

Frank R. Kearney, Attorney-at-Law
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Experienced DC Workers' Comp, Long Term Disability & Accident Lawyer