At the end of the day, a long-term disability claim is governed by a contract. You, perhaps through your employer, but with an insurance company, have an agreement where if you’re unable to work they’re to pay you benefits under the disability plan. Most people, when they’re given this type of benefit through their employer, they receive what’s called a summary plan description, which is a booklet or a short three to four-page summary of your benefits. Now, this is not your actual policy or plan. This is just a summary of the types of benefits that you’re entitled to. If you’re going to make a claim for long-term disability benefits, then you want that full policy.
Summary Plan Description v. Policy
When you purchase new car insurance, typically, the first thing that they’ll send you is a summary of coverage often called a declaration page or a one to two-page letter that summarizes the types of coverages that you have. Typically you are also given a thicker booklet that comes in the mail and might be 30, 40, or 50 pages long, and most of us just file it away. That’s your actual policy that details the entire contract.
The same thing occurs in a long term disability claim. Underlying the summary is the actual plan or policy, and I can tell you that in most instances in a long term disability case, that policy is between 20 and 50, maybe even 100 pages long. It sets out what your rights are under the policy, it spells out the benefits that you’re entitled to, but perhaps most importantly, it also shows what your burden of proof is and what you have to show in order to get your benefits. That’s why it’s extremely important for you to get a copy of this. Most of our clients don’t have a copy of the policy when they call us.
How to Obtain Your Policy
What you need to do is request a copy of your policy. The first place you can look to is the insurance company handling your case. So let’s say that you’re going through MetLife, Lincoln, or Liberty Mutual, you can contact that carrier and ask them for a copy of the policy. They may say, “We’re not the plan administrator. We don’t actually have a copy of the policy. You need to get that from the plan administrator.”
So who’s the plan administrator? That’s the person that administers the file, and it is in most instances, your employer. You may have to go back to your human resources department and ask them for a copy of the policy. Again, it’s extremely important that you get this so that you know what you have to prove in order to get benefits.
This request should be done in writing. Most people say, “Oh, I called them, and they said they would send me something, but I didn’t get anything.” Well, you should put the request in writing, and then they’re on the clock to get you the plan within 30 days. Under ERISA regulations, if they don’t provide the plan within 30 days, then they may be subject to penalties of up to $110 per day for their failure to produce the document.
In sum, that’s why it’s extremely important for you to get a full copy of your long term disability insurance policy from either your employer or the insurance company. If you’ve been denied benefits from the insurance company and are seeking assistance with obtaining your policy and filing an appeal, then I encourage you to give us a call at (866) 853-4512. Or, if you prefer to review some additional information I’m offering you a free copy of a book I wrote called the “Top 10 Mistakes That Will Destroy Your Long Term Disability Claim”.
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