Long Term Disability Frequently Asked Questions

You have a 1 in 4 chance of becoming disabled before retirement age. Disability insurance is meant to replace your wages and help with expenses in the event that you cannot work due to a disability.

Short Term Disability insurance is designed to replace a specific percentage of your pre-disability income during the first few weeks or months after the onset of a disabling illness or accident.

If the insurance coverage is under a group policy provided by the insured’s employer, the policy is likely governed by ERISA, which protects the insurance company from bad faith damages.

ERISA is a set of federal regulations that apply to insurance policies obtained through your employer, union, or employee organization that supersedes, state laws that govern employee benefits plans.

With an “own occupation” policy you may be disabled from your specific occupation, but able to perform other work, and yet unable to find other work. If so, you qualify for disability and unemployment.

SSI benefits may be reduced by other income like disability insurance benefits. However, if you have Social Security Disability, then there is no reduction of your Social Security benefits.

If you have a group policy you should contact human resources to file a disability claim application. If you have an individual disability policy you should contact your broker or insurance agent.

Most attorneys do not have the knowledge or experience to properly handle an ERISA-governed LTD claim. Unrepresented claimants may miss deadlines or fail to address critical issues in the appeal.

It is common for people to receive benefits until the policy expiration date or retirement, but you don’t have to be permanently out of work. Some people even improve enough to return to work.

A medically determinable impairment that results from anatomical, physiological, or psychological abnormalities that can be shown by medically acceptable clinical and laboratory diagnostic techniques.

HIPAA laws grant you a right to privacy. Therefore, no medical provider, including hospitals, urgent care, and doctors should give access to an insurance company without your express consent.

A physician letter that states you are disabled and unable to work will not guarantee that your claim will be approved. However, depending on the substance of the letter, it may improve your chances.

If you see multiple doctors for your disability, they should each provide a doctor’s letter. It is a “best practice” to have at least two doctors provide you with a letter for the insurance company.

Your Residual Functional Capacity is the most you can still do despite your impairment(s), and any related symptoms, such as pain, which may cause physical and mental limitations.

When you fail to follow the treatment plan recommended by an attending physician, then you are considered to be a “non-compliant” patient. Your non-compliance will be noted in the medical records.

ERISA allows insurance companies to extend the time they have to make a decision. All the insurance company has to say is that they need more information. It’s a tactic to force your return to work.

Ask your doctor to complete a residual functional capacity report. This will help outline the tasks that the doctor believes you are not able to do safely without injuring yourself further.

In ERISA disability litigation, the terminology used is a little different than “bad faith.” Federal courts will review the insurance company’s decision to determine whether the denial was “arbitrary and capricious.”

If you do not give the insurance company the chance to right its own wrongs through the appeal process first, most courts will not allow your lawsuit to proceed.

Under ERISA rules and regulations, you usually only have 180 days from the date on the insurance company’s denial letter to file your appeal.

Read the denial letter and request your free copy of your claim file from the insurer, obtain evidence to support your claim, and submit that evidence to your insurer with an appeal letter.

You must follow the terms of the insurance policy and go through each step of the appeals process with the insurance company first. Usually, you do not need to appeal if you have an individual policy.

If your claim is governed by federal ERISA regulations, then your state’s insurance laws are “pre-empted,” which means your state’s Department of Insurance has no jurisdiction.