If you are suffering from a medical condition that has left you unable to work, you may be considering filing a claim for long term disability benefits with your insurance company. If you have long term disability coverage through your employer or because you have separately purchased it, you may be eligible to receive a percentage of your income while you are unable to work. It is important for you to understand the different hurdles that you will have to overcome in order to get your claim approved. Using medical evidence, you will need to be able to prove that your symptoms and condition fit the guidelines established by your insurance company. You will also need to meet all of the requirements in order for your benefits to be approved.
Proving a Disability
Before you file your long term disability claim, you should first look at the plan description in your policy or ask your company’s human resources department for how your policy defines disability. If your injury or illness prevents you from performing the duties of your job, your insurance company should find that you are totally disabled. If your policy is one that allows benefits for partial disabilities, you may also qualify if your condition has left you unable to work full-time in your field. Some policies provide that you cannot file a claim if you are still receiving income from your employer, however.
Your treating doctor’s opinion is very important in proving your claim for long term disability benefits. Your application materials might include a form for your physician to complete or ask that your doctor writes a statement in which he or she will give his or her opinion about your medical condition and its effect on your ability to work. Because the claims administrator will want additional proof, he or she will request any medical records that are related to your condition. This may include clinical notes, MRIs, X-rays, findings, surgical reports and lab results.
While your claim is pending, it is important for you to continue seeing your doctor for treatment. You should also follow all of your doctor’s recommendations for follow-up care, and you should continue to do so after your claim is approved. Your insurance company may rely on your failure to continue your recommended treatment as a basis for terminating your benefits.
As part of your application process, your insurance company may ask you to complete a functional capacity evaluation. If you are asked to complete this test, it is important for you to talk to your long term disability attorney first. A functional capacity evaluation is a battery of assessments that are used to determine whether or not your condition prevents you from working. The evaluators who perform these tests are chosen by the insurance company, and many have an interest in making findings that comport with what the insurance company wants rather than what you need. The FCE may last for several days, and you may have to go through a series of rigorous physical tests that could potentially exacerbate your condition. The FCE is also used to determine whether or not an applicant is malingering as a reason for denying the benefits.
Requirements for Receiving Benefits
It is important for you not to let your coverage lapse for your long term disability insurance. It can do so if you fail to pay your premiums on a timely basis. If your policy is one that is provided by your employer, you may not have any required premium payments, however. If your employer does not pay for your plan, you should make certain to make your payments on time each month. If your plan is provided through your job, it likely requires that you are working full-time when you first become disabled. Full-time work may be defined under your policy as working a minimum of 30 to 35 hours each week. Your policy will contain the definition, so you can check it to make certain.
Most long term disability insurance policies have elimination periods. These are the times that last from the date of your disability and when you can start receiving your benefits. You are ineligible for disability benefits through your long term disability insurance policy until your elimination period is over. These periods often last as long as your short-term disability coverage lasts so that your long term coverage can kick in when your short-term benefits end. The insurance company is also likely to ask that you use up all of your accrued sick leave from your job before applying for short-term disability and then to use up your short-term benefits before applying for them under your long term disability policy.
Certain illnesses and injuries may not be covered by some long term disability insurance policies. It is important to review your policy to see if your injury or illness is excluded by it. Pre-existing conditions are often expressly excluded in many policies. These are classified as injuries or illnesses that were diagnosed or treated within certain time periods before the coverage started. Generally, you will not be paid for long term disabilities that happen because of pre-existing conditions for your first 12 months of long term disability coverage. Some policies also place two-year limitations on disabilities that are partly caused by nervous or mental conditions and drug or alcohol abuse. Finally, some policies also exclude specific disease or workplace injuries that result from accidents.
Will I Have to File for SSDI?
When you are approved for benefits through your long term disability coverage, your insurance company will likely require that you file a claim for social security disability benefits. The amount that you receive from your insurance company can be offset by the amount that you receive from SSDI. Insurance companies thus have vested interests in your approval for social security disability benefits. In some cases, the companies may retain disability lawyers to represent their insureds in their social security claims.
If you are approved for long term disability benefits because of a workplace injury, the company might also ask you to apply for workers’ compensation benefits. If you are approved, then your insurance company will be able to offset the amount it pays to you by the amount you receive from workers’ compensation. In order to continue receiving your long term disability benefits, it is important for you to follow through on applying for benefits for social security disability or workers’ compensation.
Getting the Benefits Your Deserve
Insurance companies commonly attempt to limit their losses by denying claims. Getting professional legal help can improve your chances of securing the benefits that you deserve from your long term disability insurance company. We can help you prove your claim. We can assist you with gathering and submitting the types of evidence that may be needed, and if necessary, litigate the matter on your behalf in the event the company tries to deny your claim. Contacting an experienced long term disability attorney from teh team at Osterhout & Berger Disability Law may make the difference in whether or not your claim for benefits is ultimately approved.
Let Us Help You Get the Benefits You Deserve
Schedule a free confidential consultation about appealing your denial by calling us toll free at 1-866-438-8773. If you prefer, you can fill out our intake form, and an experienced lawyer will contact you to schedule an appointment.