{"id":3264,"date":"2020-07-14T20:40:57","date_gmt":"2020-07-14T20:40:57","guid":{"rendered":"https:\/\/nolfinal.wpengine.com\/?p=3264"},"modified":"2024-01-26T14:43:02","modified_gmt":"2024-01-26T19:43:02","slug":"long-term-disability-insurance-overview","status":"publish","type":"post","link":"https:\/\/www.nickortizlaw.com\/long-term-disability-insurance-overview\/","title":{"rendered":"Long-Term Disability Insurance Overview"},"content":{"rendered":"\n<div class=\"wp-block-rank-math-toc-block\" id=\"rank-math-toc\" id=\"rank-math-toc\"><h2>Table of Contents<\/h2><nav><ul><li ><a href=\"#what-is-long-term-disability-insurance\">What Is Long-Term Disability Insurance?<\/a><\/li><li ><a href=\"#what-does-my-policy-cover\">What Does My Policy Cover?<\/a><\/li><li ><a href=\"#the-erisa-claims-process\">The ERISA Claims Process<\/a><ul><li ><a href=\"#sick-or-injured-but-have-not-yet-filed-a-claim\">Sick or Injured But Have Not Yet Filed a Claim<\/a><\/li><li ><a href=\"#applied-for-benefits-and-waiting-on-a-decision-for-coverage\">Applied For Benefits and Waiting on a Decision for Coverage<\/a><\/li><li ><a href=\"#applied-for-benefits-and-denied-coverage-but-appeals-are-still-available\">Applied For Benefits and Denied Coverage, but Appeals Are Still Available<\/a><\/li><li ><a href=\"#applied-for-benefits-and-denied-coverage-but-all-appeals-have-been-exhausted\">Applied For Benefits and Denied Coverage, but All Appeals Have Been Exhausted<\/a><\/li><\/ul><\/li><li ><a href=\"#working-with-a-long-term-disability-attorney\">Working with a Long-Term Disability Attorney<\/a><\/li><\/ul><\/nav><\/div>\n\n\n\n<p><a href=\"https:\/\/www.nickortizlaw.com\/practice-areas\/long-term-disability-insurance-erisa-lawyer\/\">Long-term disability<\/a>&nbsp;insurance is offered to help support you as a wage replacement if you\u2019re sick or injured and unable to work. Unfortunately, what should be a relatively straightforward claim process is anything but. Despite paying your premiums for months, years, or even decades, your insurance company may&nbsp;unfairly deny your disability insurance claim, leaving you without the steady income replacement you expected.<\/p>\n\n\n\n<h2 class=\"wp-block-heading\" id=\"what-is-long-term-disability-insurance\">What Is Long-Term Disability Insurance?<\/h2>\n\n\n\n<figure class=\"wp-block-embed is-type-video is-provider-youtube wp-block-embed-youtube youtube-embed wp-embed-aspect-16-9 wp-has-aspect-ratio\"><div class=\"wp-block-embed__wrapper\">\n<iframe loading=\"lazy\" title=\"Long Term Disability Insurance - What is it?\" width=\"500\" height=\"281\" src=\"https:\/\/www.youtube.com\/embed\/U0EpmYIMYaQ?feature=oembed\" frameborder=\"0\" allow=\"accelerometer; autoplay; clipboard-write; encrypted-media; gyroscope; picture-in-picture; web-share\" referrerpolicy=\"strict-origin-when-cross-origin\" allowfullscreen><\/iframe>\n<\/div><\/figure>\n\n\n\n<p>Long-term disability benefits (sometimes referred to as \u201cLTD\u201d benefits for short) provide vital income protection to individuals beginning a few weeks to a few months after the onset of a&nbsp;<a href=\"https:\/\/www.nickortizlaw.com\/practice-areas\/long-term-disability-insurance-erisa-lawyer\/medical-conditions\/\" data-type=\"page\" data-id=\"2224\">disabling medical condition<\/a>. It typically kicks in once the Short Term Disability benefit period ends.<\/p>\n\n\n\n<p>As with short-term disability insurance benefits, LTD benefits are designed to replace a specific percentage of your pre-disability income starting a few weeks or months after the onset of a disabling illness or accident. Policies typically provide coverage until retirement age, which is usually defined as age 65 in the policy but may also be specifically defined in the policy.<\/p>\n\n\n\n<p>You can typically purchase long-term disability insurance benefits from an insurance agent or through your employer. Some benefits you might obtain include:<\/p>\n\n\n\n<ul>\n<li>Bi-weekly or monthly benefit payments, which will pay you a portion of your <a href=\"https:\/\/www.nickortizlaw.com\/practice-areas\/long-term-disability-insurance-erisa-lawyer\/ltd-glossary-key-terms-in-policy\/pre-disability-earnings\/\">pre-disability earnings<\/a> on a bi-weekly or monthly basis for the term length of your policy and<\/li>\n\n\n\n<li>Comprehensive Rehabilitation Program benefits can provide incentives related to vocational (job) rehabilitation, dependent (child) care, workplace modifications, and more.<\/li>\n<\/ul>\n\n\n\n<h2 class=\"wp-block-heading\" id=\"what-does-my-policy-cover\">What Does My Policy Cover?<\/h2>\n\n\n\n<p>Long-term disability is designed to cover various illnesses and ailments. &nbsp;Some people think that long-term disability only covers injuries that happen on the job. However, although on-the-job injuries may be covered, more than 95% of long-term disability claims are believed to be non-work-related. For example, injuries suffered outside of work,&nbsp;cancer, auto-immune disorders,&nbsp;mental illness, chronic illnesses,&nbsp;neurological disorders, and degenerative diseases are likely to be covered by a long-term disability policy. This list is incomplete, but it gives examples of <a href=\"https:\/\/www.nickortizlaw.com\/practice-areas\/long-term-disability-insurance-erisa-lawyer\/medical-conditions\/\" data-type=\"page\" data-id=\"2224\">conditions that may qualify for benefits<\/a>.<\/p>\n\n\n\n<h2 class=\"wp-block-heading\" id=\"the-erisa-claims-process\">The ERISA Claims Process<\/h2>\n\n\n\n<p>Here, we look at a general overview of the claims process and appeals procedures in <a href=\"https:\/\/www.nickortizlaw.com\/ltd-faq\/what-is-erisa-and-what-does-it-have-to-do-with-my-ltd-claim\/\">ERISA disability claims<\/a>.<\/p>\n\n\n\n<figure class=\"wp-block-image size-full is-resized\"><img loading=\"lazy\" decoding=\"async\" width=\"1024\" height=\"768\" src=\"https:\/\/www.nickortizlaw.com\/wp-content\/uploads\/2024\/01\/Long-Term-Disability-Claim-Process-Overview.png\" alt=\"Long-Term Disability Claim Process Overview\" class=\"wp-image-8490\" style=\"width:840px;height:auto\" srcset=\"https:\/\/www.nickortizlaw.com\/wp-content\/uploads\/2024\/01\/Long-Term-Disability-Claim-Process-Overview.png 1024w, https:\/\/www.nickortizlaw.com\/wp-content\/uploads\/2024\/01\/Long-Term-Disability-Claim-Process-Overview-300x225.png 300w, https:\/\/www.nickortizlaw.com\/wp-content\/uploads\/2024\/01\/Long-Term-Disability-Claim-Process-Overview-768x576.png 768w, https:\/\/www.nickortizlaw.com\/wp-content\/uploads\/2024\/01\/Long-Term-Disability-Claim-Process-Overview-800x600.png 800w, https:\/\/www.nickortizlaw.com\/wp-content\/uploads\/2024\/01\/Long-Term-Disability-Claim-Process-Overview-550x413.png 550w, https:\/\/www.nickortizlaw.com\/wp-content\/uploads\/2024\/01\/Long-Term-Disability-Claim-Process-Overview-350x263.png 350w, https:\/\/www.nickortizlaw.com\/wp-content\/uploads\/2024\/01\/Long-Term-Disability-Claim-Process-Overview-260x195.png 260w\" sizes=\"(max-width: 1024px) 100vw, 1024px\" \/><\/figure>\n\n\n\n<div style=\"height:20px\" aria-hidden=\"true\" class=\"wp-block-spacer\"><\/div>\n\n\n\n<ol>\n<li>The first thing you should do is contact your employer\u2019s human resources department for your disability insurance plan\u2019s specific procedure details. Do not simply make this request verbally. Make the request in writing. Your disability insurance company should send you a written procedure or application for free.<\/li>\n\n\n\n<li>Make sure you note any deadlines to file the claim.<\/li>\n\n\n\n<li>File the claim before the deadline.<\/li>\n\n\n\n<li>The insurance company may request additional information to decide the claim. The insurer will advise you of any deadlines to submit the additional information. Remember, it is your burden to prove you have a disability. It is not the insurance company\u2019s burden to prove you are not disabled. Therefore, provide whatever documentation necessary to satisfy your \u201cburden of proof.\u201d<\/li>\n\n\n\n<li>If you are approved, then you will start drawing your benefits. If you are denied, your insurance company should advise you of its decision in writing. You have the right to appeal the decision if you receive a denial.<\/li>\n\n\n\n<li>Make sure to note any deadlines to file your appeal. The deadline is likely in the insurance company\u2019s denial letter.<\/li>\n\n\n\n<li>File your formal notice of appeal within the time limits, typically 180 days.<\/li>\n\n\n\n<li>The insurance company will again review your appeal and issue a new decision. If your claim is approved, you will begin to draw your benefits and any past-due benefits. The insurance company should advise you of your appeal rights in the denial letter if you are denied.<\/li>\n\n\n\n<li>Once you have exhausted all your administrative appeals, you can file a lawsuit in federal court, challenging the insurance company\u2019s wrongful denial of your claim.<\/li>\n<\/ol>\n\n\n\n<h3 class=\"wp-block-heading\" id=\"sick-or-injured-but-have-not-yet-filed-a-claim\">Sick or Injured But Have Not Yet Filed a Claim<\/h3>\n\n\n\n<p>Complex claim paperwork is the last thing on your mind when you are struggling with sickness, illness, or an injury. While you may have a long-term disability policy, you may not know what benefits the insurance contract affords, what the&nbsp;policy covers, how to file a claim, the time limits to file a claim, and what you need to do next. <\/p>\n\n\n\n<p>This is where The Ortiz Law Firm can help. Our <a href=\"https:\/\/resources.nickortizlaw.com\/free-ltd-book\">free book on long-term disability claims<\/a> can help you recover the benefits you may be entitled to. Topics in the book include:<\/p>\n\n\n\n<ol>\n<li>Understanding Your Policy;<\/li>\n\n\n\n<li>Common Mistakes in Filing a Claim; and<\/li>\n\n\n\n<li>When to Seek Legal Advice From an Attorney.<\/li>\n<\/ol>\n\n\n\n<p class=\"blockquote\"><strong>FREE RESOURCE: <\/strong>Prepare to File Your LTD Claim with our <a href=\"https:\/\/resources.nickortizlaw.com\/disability-insurance-claim-guide\">Disability Insurance Claim Guide and Toolkit<\/a>.<\/p>\n\n\n\n<h3 class=\"wp-block-heading\" id=\"applied-for-benefits-and-waiting-on-a-decision-for-coverage\">Applied For Benefits and Waiting on a Decision for Coverage<\/h3>\n\n\n\n<p>If you\u2019ve applied for long-term disability benefits and you still haven\u2019t heard a response from your disability insurance carrier, you should contact them for the status of your claim. \u00a0Intentionally delaying a claim decision is one way some insurers demonstrate <a href=\"https:\/\/www.nickortizlaw.com\/ltd-faq\/when-is-an-insurance-company-considered-to-have-committed-a-bad-faith-denial-of-a-disability-claim\/\" data-type=\"page\" data-id=\"3770\">bad faith<\/a> in failing to honor their contract with you. Without an official denial, you\u2019re unable to appeal. However, you may have the right to go right to court under certain circumstances<\/p>\n\n\n\n<h3 class=\"wp-block-heading\" id=\"applied-for-benefits-and-denied-coverage-but-appeals-are-still-available\">Applied For Benefits and Denied Coverage, but Appeals Are Still Available<\/h3>\n\n\n\n<p>Too often, legitimate long-term disability claims are denied or wrongfully terminated because insurance companies look for every possible legal and technical reason to deny or cut off a valid claim. In most circumstances, if your initial application is denied, you can file one or more <a href=\"https:\/\/www.nickortizlaw.com\/practice-areas\/long-term-disability-insurance-erisa-lawyer\/appeals\/\" data-type=\"page\" data-id=\"77\">appeals with the insurance company<\/a>. If you previously received LTD benefits and the insurance company wrongfully terminated your benefits, you also have the right to appeal the cessation of benefits.<\/p>\n\n\n\n<p>If you have been denied coverage for benefits, you should make sure you appeal the decision using the administrative process outlined by your insurance company. However, you should also remember that appeals are not always required before filing a lawsuit in certain circumstances. That\u2019s why you should consult with an experienced LTD attorney to discuss your legal rights.<\/p>\n\n\n\n<p class=\"blockquote\"><strong>FREE RESOURCE: <\/strong>Appeal a Long-Term Disability Denial with our <a href=\"https:\/\/www.nickortizlaw.com\/how-to-appeal-an-ltd-denial\/\" data-type=\"post\" data-id=\"3255\">Disability Insurance Appeal Guide<\/a> <\/p>\n\n\n\n<h3 class=\"wp-block-heading\" id=\"applied-for-benefits-and-denied-coverage-but-all-appeals-have-been-exhausted\">Applied For Benefits and Denied Coverage, but All Appeals Have Been Exhausted<\/h3>\n\n\n\n<p>At some point, no more appeals will be available to you. &nbsp;In such an event, the insurance company will tell you that you have \u201cexhausted\u201d all of your administrative appeals. You then have the right to <a href=\"https:\/\/www.nickortizlaw.com\/practice-areas\/long-term-disability-insurance-erisa-lawyer\/lawsuits\/\" data-type=\"page\" data-id=\"842\">sue the insurance company<\/a> in State or Federal Court.<\/p>\n\n\n\n<h2 class=\"wp-block-heading\" id=\"working-with-a-long-term-disability-attorney\">Working with a Long-Term Disability Attorney<\/h2>\n\n\n\n<p><a href=\"https:\/\/www.nickortizlaw.com\/about-us\/our-team\/nick-ortiz\/\" data-type=\"page\" data-id=\"3656\">Nick Ortiz<\/a> is an experienced long-term disability attorney. &nbsp;We here at the <a href=\"https:\/\/www.nickortizlaw.com\/about-us\/\" data-type=\"page\" data-id=\"1095\">Ortiz Law Firm<\/a> have assisted claimants in filing internal \u201cadministrative\u201d appeals with the insurance company to maximize the chances that your LTD claim will be approved or reinstated since 2012.<\/p>\n\n\n\n<p>We have a \u201cZero Fee Guarantee,\u201d which means our clients only pay an attorney fee when disability benefits are recovered. We handle long-term disability claims at every level of appeal, including:<\/p>\n\n\n\n<ul>\n<li>The first administrative appeal;<\/li>\n\n\n\n<li>The second administrative appeal;<\/li>\n\n\n\n<li>All \u201coptional\u201d levels of appeal;<\/li>\n\n\n\n<li>Litigation claims in state court (for individual disability insurance claims, church plans, and government employees) and<\/li>\n\n\n\n<li>Litigation claims in federal court for ERISA claims.<\/li>\n<\/ul>\n\n\n\n<p>Call us today at <strong><a href=\"tel:8883218131\">(888) 321-8131<\/a><\/strong> to schedule a <strong>free, no-obligation disability case review<\/strong>.<\/p>\n","protected":false},"excerpt":{"rendered":"<p>Long-term disability&nbsp;insurance is offered to help support you as a wage replacement if you\u2019re sick or injured and unable to work. Unfortunately, what should be a relatively straightforward claim process is anything but. Despite paying your premiums for months, years, or even decades, your insurance company may&nbsp;unfairly deny your disability insurance claim, leaving you without &hellip;<\/p>\n","protected":false},"author":2,"featured_media":4944,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"_genesis_hide_title":false,"_genesis_hide_breadcrumbs":false,"_genesis_hide_singular_image":false,"_genesis_hide_footer_widgets":false,"_genesis_custom_body_class":"","_genesis_custom_post_class":"","_genesis_layout":"","footnotes":""},"categories":[207],"tags":[],"_links":{"self":[{"href":"https:\/\/www.nickortizlaw.com\/wp-json\/wp\/v2\/posts\/3264"}],"collection":[{"href":"https:\/\/www.nickortizlaw.com\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/www.nickortizlaw.com\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/www.nickortizlaw.com\/wp-json\/wp\/v2\/users\/2"}],"replies":[{"embeddable":true,"href":"https:\/\/www.nickortizlaw.com\/wp-json\/wp\/v2\/comments?post=3264"}],"version-history":[{"count":0,"href":"https:\/\/www.nickortizlaw.com\/wp-json\/wp\/v2\/posts\/3264\/revisions"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/www.nickortizlaw.com\/wp-json\/wp\/v2\/media\/4944"}],"wp:attachment":[{"href":"https:\/\/www.nickortizlaw.com\/wp-json\/wp\/v2\/media?parent=3264"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/www.nickortizlaw.com\/wp-json\/wp\/v2\/categories?post=3264"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/www.nickortizlaw.com\/wp-json\/wp\/v2\/tags?post=3264"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}