You are likely familiar with your employee benefits package when it comes to health insurance or retirement programs. But for many employees, long-term disability benefits are an afterthought, not considered as critical as other parts of the package. That is, until you suffer a serious injury or illness and you must count on long-term disability as a major source of income. Hundreds of thousands of people each year find themselves in this precarious position.
Long-term disability coverage is also available as an individual policy you purchase yourself. Whether it is a group or individual policy, this insurance allows you to receive income in case you are injured or become ill and unable to work. It differs from workers’ compensation insurance, which only covers on-the-job injuries or work-related illnesses. In most cases, long-term disability policies provide between 50 and 60 percent of your income if you prove unable to work.
Long-Term Disability and ERISA
If your long-term disability policy is part of your employer’s group plan, it probably falls under the federal Employee Retirement Income Security Act of 1974 or ERISA. By law, you must receive information regarding your coverage and benefits and instructions on how to file a claim.
If the claim is denied, under ERISA the applicant can appeal the decision. If the appeal is denied, the applicant can file a lawsuit against the insurer or their employer for benefits.
When Can You File for Long-Term Disability?
When you can file for long-term disability depends on your policy’s elimination period[AU1] and probationary period, which are not synonymous. The former is the number of days that must pass since the beginning of your disability before you can receive benefits. The latter is a short period of time, if the policy requires it at all, designed to prevent the coverage of pre-existing conditions. Most long-term disability policies do not include a probationary period.
File for long-term disability once your elimination period, as per your policy, is over. Typically, the elimination period runs between 90 and 180 days.
Steps for Applying for Long-Term Disability
Start the process by requesting a long-term disability application form from your company’s Human Resources department. If for some reason your employer cannot provide the form and instructions, visit the insurance company’s website to find an online application.
After obtaining the application, complete the following steps:
Employee’s Statement
This form requires the submission of your personal information, including your name, birth date, Social Security number, address, and phone number. In addition, you must provide:
- Name of employer
- Work history
- Education
- Date you were injured or became ill
- Disability diagnosis
- Last day at work
- All healthcare providers with contact information
- Any prescription medications
- Eligibility for other types of income
Employer’s Statement
Your employer must fill out part of the form. This statement from your employer must include:
- Hire date
- Occupation title
- Physical occupation requirements
- Mental occupation requirements
- Date insurance coverage began
- Earnings
- Last day of work
- Other insurance benefits
- Other income you might receive, such as commissions
Attending Doctor Statement
You must also submit a statement from your attending physician. This statement must include information regarding:
- Your diagnosis
- Signs and symptoms
- Objective findings
- Treatment dates
- Whether your condition is work-related
- Any mental impairments
- Any physical limitations
- Work return estimate
Supporting Documents
It is up to you to ensure that the insurer receives all pertinent evidence for your disability claim. Collect and submit supporting documentation for your application, such as medical records. The insurance administrator needs all the information available that might boost your long-term disability claim.
How Can a Long-Term Disability Lawyer Help?
A long-term disability lawyer examines your policy thoroughly to determine its exact terms and conditions. They will also note any policy limitations. Having an attorney to guide you and advocate on your behalf means there is less likelihood of needing to submit additional information, which delays the process. It is also less likely that your benefits will be denied due to particular terms in the policy. Your lawyer is well-versed in your policy’s terms and submits your application based on its terms and conditions.
Keep in mind that insurance companies look for ways to deny claims. It is part of their business model. For instance, the insurer may argue that your condition was pre-existing and therefore you are ineligible for benefits. Your lawyer knows how to dispute this argument and is familiar with the appeals process.
With ERISA, you are limited to one appeal within 180 days of the initial claim denial letter date. Your attorney ensures the deadline is met and will help you collect any additional evidence needed to support the appeal.
Contact a Long-Term Disability Attorney
If your disability claim has been denied by your insurer, contact a long-term disability lawyer at Marc Whitehead & Associates. Schedule a free, no-obligation consultation today. We fight for your rights so that you may receive the long-term disability benefits you deserve.
