• Menu
  • Skip to right header navigation
  • Skip to main content
  • Skip to secondary navigation
  • Skip to primary sidebar
  • Skip to footer

Before Header

Has your disability claim been wrongfully denied or terminated? Call us today for help!  (888) 321-8131

  • Facebook
  • Instagram
  • LinkedIn
  • Twitter
  • YouTube

National Disability Law Firm | Ortiz Law Firm

We appeal wrongful long term disability insurance and Social Security Disability denials.

  • ABOUT US
    • Our Team
    • Our Results
    • Areas We Serve
    • Core Values
  • PRACTICE AREAS
    • Administrative Appeals
    • Lawsuits
    • Lump Sum Settlement Offers
  • RESOURCES
    • Top 10 Mistakes That Will Destroy Your Long Term Disability Claim
    • Lump Sum Disability Settlement Calculator
    • Physical RFC Form
    • Mental RFC Form
    • Ultimate Appeal Checklist
    • Long Term Disability Case Study
  • BLOG
    • Long Term Disability Denials and Appeals
    • Medical Eligibility for Long Term Disability Claims
    • Eligibility for Long Term Disability Claims
    • Your Chances of Getting Approved for Disability Benefits
    • Additional Parts Of A Claim That Do Not Happen in Every Case
  • Search
  • CONTACT
  • ABOUT US
    • Our Team
      • Nick Ortiz
      • Jessica Ortiz
      • Dawn Keller
      • Tory Nelson
      • Sarah Palag
    • Core Values
    • Our Results
      • Why Choose Ortiz Law Firm
      • What Our Clients Say
      • Testimonials
  • PRACTICE AREAS
    • Long Term Disability Claims
      • Administrative Appeals
      • Lawsuits
      • Lump-Sum Settlement Offers
      • Qualifying Conditions
      • Disability Insurance Companies
      • Qualifying Occupations
      • Case Summary Archives
      • FAQs
    • Social Security Disability Claims
      • Initial Application
      • Request for Reconsideration
      • Hearing Before an Administrative Law Judge
      • Qualifying Conditions
      • FAQs
    • Personal Injury Claims
      • Car Accident Claims in Pensacola, Florida
      • Bicycle Accident Claims in Pensacola, Florida
      • Motorcycle Accident Claims in Pensacola, Florida
      • Truck Accident Claims in Pensacola, Florida
      • Slip & Fall
      • Insurance Companies
      • FAQs
  • AREAS WE SERVE
  • RESOURCES
    • Top 10 Mistakes That Will Destroy Your LTD Claim
    • Top 10 Mistakes That Will Destroy Your SSD Claim
    • Lump Sum Disability Settlement Calculator
    • Physical Residual Functional Capacity Form
    • Mental Residual Functional Capacity Form
    • Ultimate LTD Appeal Checklist
    • LTD Case Study: Fibromyalgia
    • Top 10 Mistakes That Will Destroy Your FL Car Accident Claim
  • BLOG
    • Long Term Disability
      • Eligibility for Long Term Disability Claims
      • Medical Eligibility for Long Term Disability Claims
      • Your Chances of Getting Approved for Disability Benefits
      • Long Term Disability Denials and Appeals
      • Additional Parts Of A Claim That Do Not Happen in Every Case
    • Social Security Disability
    • Personal Injury
  • REFER A CASE
  • Search
  • CONTACT

Mobile Menu

Schedule A Free Consultation Now!

Find out how our law firm can help you win your case or you don’t pay a cent.

(888) 321-8131

  • Facebook
  • LinkedIn
  • Twitter
  • YouTube

LTD Plan – A Policy Breakdown

July 14, 2020 //  by Dawn Keller//  Leave a Comment


Definition of Disability

Under the terms of a typical Long Term Disability Plan (hereinafter “Plan”), you are entitled to long term disability (“LTD”) benefits when the insurance company “determines” that:

  • you are unable to perform the material and substantial duties of your regular occupation due to your sickness or injury; and
  • you have a 20% or more loss in your indexed monthly earnings due to that sickness or injury.

After 24 months of payments, you are considered disabled under the terms of the Plan when the insurance company determines that, due to the same sickness or injury, you are unable to perform the duties of any gainful occupation for which you are reasonably fitted by education, training or experience.

The loss of a professional or occupational license or certification does not, in itself, constitute a disability.

The insurance company may require you to be examined by doctors, other medical practitioners or vocational experts of the insurance company’s choice. The insurance company will pay for these examinations. The insurance company can require examinations as often as it is reasonable to do so. The insurance company may also require you to be interviewed by an authorized representative of the insurance company. Refusal to be examined or interviewed may result in denial or termination of your claim.

Material and substantial duties means duties that:

  • are normally required for the performance of your regular occupation; and
  • cannot be reasonably omitted or modified ….

Regular occupation means the occupation you are routinely performing when your disability begins. The insurance company will look at your occupation as it is normally performed instead of how the work tasks are performed for a specific employer or at a specific location.

Gainful occupation means an occupation, including self-employment, that is or can be expected to provide you with an income equal to at least 60% of your indexed monthly earnings within 12 months of your return to work.

A typical Plan will further provide terms and conditions similar to the following:

What Disabilities Have a Limited Pay Period Under Your Plan?

Disabilities due to a sickness or injury which, as determined by the insurance carrier, are primarily based on self-reported symptoms have a limited pay period during your lifetime.

Disabilities which, as determined by the insurance carrier, are due in whole or part to mental illness also have a limited pay period during your lifetime.

The limited pay period for self-reported symptoms and mental illness combined is 24 months during your lifetime.

Self-reported symptoms means the manifestations of your condition, which you tell your doctor, that are not verifiable using tests, procedures and clinical examinations standardly accepted in the practice of medicine. Examples of self-reported symptoms include, but are not limited to headache, pain, fatigue, stiffness, soreness, ringing in ears, dizziness, numbness, and loss of energy.

Mental illness means a psychiatric or psychological condition regardless of cause. Mental illness includes but is not limited to schizophrenia, depression, manic depressive or bipolar illness, anxiety, somatization, substance-related disorders and/or adjustment disorders or other conditions.

Ortiz Law Firm Provides Aggressive Representation to Long Term Disability Claimants

Unfortunately, long term disability carriers do not make it easy for disabled claimants to receive the benefits that they deserve. If you have been denied your long term disability benefits, the legal team at Ortiz Law Firm can help you cut through the red tape and fight for your disability benefits no matter where you live in the United States. Give us a call today to discuss your claim at (866) 853-4512.

Facebook0Tweet0Pin0LinkedIn0Print0Email0

Category: Long Term Disability

Recent Posts

  • How to Write a Long Term Disability Appeal Letter & Why Most Appeals Suck
  • How to Improve Your Chances of Getting Disability
  • Own Occupation vs. Any Occupation: What’s The Difference?
  • An Independent Medical Examination (IME) by an Independent Medical Physician
  • How to Appeal a Long Term Disability Denial: Tips for Your Appeal
Previous Post: « Long Term Disability: Information & Criteria
Next Post: LTD: The Application and Determination Process »

Reader Interactions

Leave a Reply Cancel reply

Your email address will not be published. Required fields are marked *

Primary Sidebar

View All Resources


Rhonda B.

Don't try to navigate disability on your own! Mr. Ortiz and his group care for the client and their situation. They walked me through every step of the claims process and provided help to me in a time of desperate need. They are honest, professional, and understand their clients' hardships.

View All Testimonials

Complete this CONFIDENTIAL form or call (888) 321-8131 for a FREE case evaluation

  • This field is for validation purposes and should be left unchanged.

Navigation

  • Free Resources
  • Qualifying Conditions for LTD
  • LTD Insurance Companies
  • Qualifying Occupations for LTD
  • Case Summary Archives
  • LTD FAQ
  • Qualifying Conditions for SSD
  • SSD FAQ
  • PI FAQ
  • PI Insurance Companies
  • Disclaimer

Footer

Our Team

  • Nick Ortiz
  • Jessica Ortiz
  • Dawn Keller
  • Sarah Palag
  • Tory Nelson

Our Law Office

ORTIZ LAW FIRM
(888) 321-8131

823 E. Jackson St.
Pensacola, FL 32501
Monday - Thursday: 9:00 AM - 5:00 PM Friday: 9:00 AM - 2:00 PM

Saturday - Sunday: Closed

Practice Areas

  • Long Term Disability Claims
  • Social Security Disability Claims
  • Personal Injury Claims
  • Facebook
  • LinkedIn
  • Twitter
  • YouTube
  • Free Long Term Disability Resources
  • Long Term Disability Frequently Asked Questions
  • Medical Conditions That May Qualify for Long Term Disability
  • LTD Insurance Carriers
  • Occupations That May Qualify for LTD
  • LTD Blog
  • LTD Federal Court Case Summaries
  • Contact
  • Disclaimer

Site Footer

©2020 Ortiz Law Firm, All Rights Reserved. Reproduced with Permission | Privacy Policy

Share this ArticleLike this article? Email it to a friend!

Email sent!