Long Term Disability
Many employees believe that they will automatically be covered by disability insurance policies. But, many who qualify for benefits discover that insurance companies do not readily make good on their policies.
If you have suffered an on-the-job injury, been injured in a car accident or fallen ill with a long-term or even terminal disease, you may qualify for long term disability insurance benefits. Obtaining those benefits is not easy. Too often ERISA is used against employees.
You may have already applied for long term disability benefits. The insurance company may be putting up roadblocks. You need an experienced long term disability lawyer to enforce your rights under the policy and under the law.
Contact an experienced ERISA long term disability lawyer today for help with your claim for long term disability benefits.
How do I qualify for long term disability?
The terms of the long term disability insurance plan or policy will set forth the requirement for qualifying for long term disability. You may think that if you are hurt or sick that your income is protected. However, when you look at the details of your policy or plan, it may not provide the benefits you thought you had. It may, in fact, provide little or nothing at all.
If there is a long term disability policy or plan, then you qualify for long term disability benefits when the conditions set forth in the policy are met. There may be other benefits available if you become disabled, such as Social Security disability or Supplemental Security Income (which are government-provided benefits), and disability pension benefits (provided by a pension plan).
Examine your disability policy or plan to see what is covered before you file a claim. An experienced long term disability lawyer can help you interpret your plan documents.
What medical conditions qualify for long term disability?
You may apply for long term disability benefits through an employer-provided or private insurance plan, based upon a number of medical conditions such as heart disease, cancer, anxiety, depression, lung cancer, degenerative disc disease, or Parkinson's disease. But insurance companies regularly deny such long term disability claims, arguing that they are not long term or otherwise don’t qualify.
For a list of disabling medical conditions which a long term disability attorney at The Martin Law Group can help you pursue long term disability benefits, click here.
You must meet the definition of disability in your policy or plan.
Just because you have trouble performing your job duties does not mean that you meet the definition of disability. Many policies and plans define disability as the inability to perform any occupation – not just your own occupation.
Some policies only insure or cover your inability to perform any part-time occupation working 25 hours or more per week. Such a job may not exist near you. And part-time protection is not much protection. You may need two years or more of benefits if you are disabled from your job. Unless you have a huge cash reserve, paying money for a policy that does not protect your income does little good. A long term disability lawyer can help you interpret your policy.
If your disability policy or plan does not provide the benefits that you need, you may have other options.
If you purchased a private policy, you may be able to switch policies. If it is a policy or plan through your employer, you need to contact your employer's human resources or benefits department, and ask them to search for a better policy or plan. Or, you may need to purchase your own private disability policy in addition to that benefit. A long term disability lawyer can help you explore your options.
There may be exclusions to coverage even if you meet the definition of disability.
Some policies will exclude or severely limit coverage for certain disabling conditions such as back or leg pain, fibromyalgia, or chronic fatigue syndrome. Some policies limit coverage to only one or two years for conditions like a neuromusculoskeletal disorder, fibromyalgia, arthritis or chronic fatigue syndrome. Other policies may go further and exclude coverage for any pre-existing condition that contributes to disability. That exclusion is regularly abused by insurance companies.
Some policies exclude coverage for anything that is not "objectively verifiable." Objectively verifiable may be defined as proof of disability from an x-ray or some other diagnostic test. Unfortunately, pain and many other conditions cannot be x-rayed.
Watch for policies or plans with these exclusions or limitations of coverage. Ask an experienced disability lawyer to help you determine what you plan covers.
How do I file a long term disability claim?
The process for filing a long term disability claim will be set forth in your plan document. You may have been given a summary of it when you were hired or when your employer adopted the plan. It may have an outline of the claim procedure. But usually, you will have to get the entire plan from the plan administrator, which is usually the insurance company who provides the benefits.
You must follow all of the prescribed procedures in the plan in order to preserve your rights. Adhering to the rules at the early stages of your claim and any appeal can make the difference between success and failure in a subsequent lawsuit to enforce your rights.
How long do I have to file a long term disability claim?
Your long term disability insurance plan or policy should state when a claim must be filed. The ERISA regulations (the federal regulations which apply to long term disability plans provided by employers) regarding time frames and deadlines are very technical and rigid.
The benefits claim procedures are set out in federal regulations and provide as follows for long term disability claims:
A long term disability insurance company has 45 days to accept or reject your claim.
The insurance company can inform you within that 45-day period that it needs a 30-day extension for a good cause.
The company may request yet another 30-day extension during the first 30-day extension.
All in all, the insurance company may take up to 105 days to make a decision on your claim.
If the company requests information from you during the claim process, it may seek to prolong the 105-day period even more.
If your claim is denied, you must appeal or request a review within the time period in the policy or plan, which must be at least 180 days for a disability plan.
If you claim is denied, you should consult with a disability attorney as soon as possible to maximize your chances for a successful appeal. A long term disability lawyer must make sure that your claim record is as complete as possible, as it will be the basis of any appeal.
A proper and complete claim file is critical. So, getting a long term disability lawyer on board as soon as possible is important as the deadlines for doing so and perfecting an appeal are not long. Ultimately, your long term disability claim record will be reviewed by a judge if you have to file an ERISA lawsuit because the insurance company denies your claim.
Can my long term disability claim be denied later?
This happens all the time. We have represented claimants who received benefits for over 20 years before their benefits were denied and stopped. You would think that this only happens when someone’s condition improves, but that rarely happens. Sometimes insurance companies do this because they think they can get away with it. A new adjustor takes over, or the company is sold, and they want to show their boss how wonderful they are by saving money. Or, there is a concentrated effort by a new director of the department telling the adjuster to deny claims so they can increase profits.
Wrongfully terminating a long term disability benefit is actionable.
If a company wrongfully terminates long term disability benefits, a court can make them pay the benefits they should have been paid to begin with. However, no punitive damages nor mental anguish damages are allowed. It doesn’t matter how much grief they put anyone through. ERISA does allow attorney’s fees, though they are not regularly awarded.
Contact an experienced disability attorney today for a free initial consultation
If you are thinking about filing a long term disability claim or your long term disability claim has been denied, you need the help of an experienced ERISA attorney.
Contact us today by completing the form below, chatting with an operator available 24/7, or calling us at 800-284-9309.
We offer creative fee agreements for our clients.
We agree to stay with clients for 5-10 years and sometimes longer. We spread our contingent fee out over that time to make it a little easier, and then, we stay in place to defend the claim. We diligently protect the right to continue to receive disability benefits.
Does that mean we have to file a lawsuit twice if necessary? Yes, and we have!
Does that mean we have to file an appeal two times and fend off a claim termination repeatedly? Yes, and we have many times.