Don't Let The Insurance Company Take Advantage Of You 

If you have a medical condition or injury that prevents you from working, you may be entitled to long term disability benefits. Many employers in the DC metro area offer long term disability benefits as part of the employment benefit package. You may have also purchased a private disability policy as well.

Whether you have an employer sponsored long term disability plan, or your own disability policy that you purchased, here are three tips you should know when applying for long-term disability.

1) Analyze Your Policy

If you have an employer provided policy, it is probably covered by ERISA (Employee Retirement Income Security Act), a federal law providing certain rights, obligations, and protections for employees and employers.

There are a number of companies that provide long term disability insurance, like Guardian, Unum, Hartford, Sun Life, and many others - and every policy is different.

One of the first things you should do is request a copy of your policy from your employer's human resources department and analyze all of the terms and conditions in that policy. This is critical because the language of that insurance policy will govern your entitlement to long term disability benefits, what you have to prove, your appeal rights, and everything else regarding your claim.

You need to to determine if any conditions you have are excluded from the policy, how your specific insurance policy defines your occupation, how disability is defined, and whether there are any limitations on benefits for specific medical conditions or injuries. There may also be offsets for other income benefits or other potential recoveries regarding your injury or medical condition.

So review, analyze, and study your insurance policy.

2) Work With Your Doctors To Prove You Are Disabled Under The Policy 

Make sure you get complete copies of all of your medical records, test results, diagnostic imaging, and documentation of any medical treatment you have had for your injury or medical condition. Once you review and analyze all of your medical records, you will have to decide whether you need additional medical support to document the extent of your restrictions and limitations. For example, you may need to see a specialist who can outline the specifics of your condition and why you cannot work.

This goes along with analyzing your policy, so that you can educate your physicians on how your specific insurance policy defines disability. Remember, your doctor may think it is enough just to say that you cannot return to work but under the policy, you may need specific medical documentation of your physical or cognitive limitations and restrictions in order to obtain benefits.

For the people we work with, we have a specific process for working with physicians and other medical consultants and experts. You may need to meet with your physicians separately to review the terms and conditions of your policy and help them write a report that supports your claim. In our experience, most doctors will do this, however, they may charge you a separate fee.

3) Nail Down Your Job Description

And again, you will need to determine how your long-term disability insurance policy defines your job. Many policies will define your job as your “own occupation” (although many policies will change to “any occupation” after a period of time, usually 24 or 36 months - another reason to analyze and understand the nitty-gritty details of your policy).

If that is the case, take the time to draft a job description that captures all of the physical or cognitive demands of your job. You should also get the corporate job description that your employer has so you can compare that to what your occupation actually requires. Many times, the company job description is too vague to be helpful.

You may also need to research how your job is defined in the national economy, if that is how your insurance policy defines it to make sure that your medical restrictions and limitations match up with the physical and mental requirements of the position.

Finally, we typically interview and prepare signed statements from coworkers and others who have knowledge of the specifics of your job and why you can no longer perform the essential duties of the job due to your medical condition or injury.

Speak To An Experienced Long Term Disability Attorney Today

Are you applying for long term disability or appealing the insurance company's decision to deny your benefits? It can be difficult, especially when you are coping with a serious injury or medical condition that prevents you from working. Call us today at 202-393-3320 and you'll speak to an experienced member of our staff who can help you stand up to the insurance company. 

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