Long Term Disability Claims and Benefits
Long-term disability (LTD) benefits are offered by many employers in the Kansas City metro region and throughout the country. As a long-term disability lawyer, I see firsthand how LTD benefits can help our clients meet their financial responsibilities while they are disabled, unable to work, and not getting paid regular wages.
However, not all employers offer LTD insurance, and many times, an employee must sign up for it or may even have to pay a portion of the monthly premiums. If you are uncertain as to whether you have this benefit, you should contact your employer’s human resources office. They will be able to provide you with that information and give you a claim form when you are ready to file a disability claim.
6 Things Our Kansas City LTD Lawyer Wants You to Know
The law governing long-term disability is complex and confusing. To help, here's a list of 6 things you should know about long term disability benefits, claims and appeals:
1. Waiting or Elimination Periods.
There is generally a waiting period, also known as the "Elimination Period," between the date you are declared disabled by a medical provider and when you can receive long term disability benefits. Most long-term and short-term disability policies require this waiting period to expire prior to you making a claim for LTD benefits. The average waiting period is about 90 days, but we have policies with waiting periods between 30 and 180 days. Many times, there is a short-term (STD) disability policy that is in effect during the waiting period so you should check with your benefits coordinator if that applies to you.
2. The Insurance Company Decides If Your Claim Is Approved or Denied.
If it feels like the deck is stacked against you in an LTD claim, you are correct. Who decides whether your claim is approved or denied? The insurance company decides whether to pay the claim, NOT your employer. Your employer purchased the group LTD plan from the insurance company, and the insurance adjuster (or its claims administrator) makes the decision as to whether or not they will pay your LTD claim. Knowing this, it should be no surprise that many LTD claims are denied when they should have been approved.
3. The Appeal Process Favors Insurance Company.
Every long-term disability policy should have an appeal process, which sets out what to do once one is rejected. This process allows the claimant to provide additional information to the insurance company with the hope of getting a denied claim approved. Of course, the appeals process rules are written to favor the insurance company and overturning a denied LTD claim is very difficult and time-consuming. For these reasons, we strongly encourage those with denied LTD claims to contact an attorney for assistance. Most policies only give you one chance to submit an administrative appeal, and if it is insufficient or incomplete, your claim will be dead on arrival.
4. Approvals Aren't Forever.
Some disability policies require reevaluations after so many payments. That’s right, your disability insurance, if approved for payment, will be reevaluated continually to ensure that your disability status has not changed. In other words, just because you are approved for benefits does not mean they cannot deny you later. We see this happen all of the time. You will be required to go through evaluations periodically depending on the insurance company associated with your disability policy. It is critical that you keep up with this process so that your benefits continue until they are exhausted.
5. Follow Your Doctor's Advice.
Following your doctor’s advice is crucial when it comes to LTD disability claims. Insurance companies will rely on your medical records, along with your doctor's opinions, to determine whether you are disabled enough not to work. You should not only follow your doctor’s advice but also tell your doctor that you are filing for disability benefits. This will ensure that your medical records are accurate and completely describe your medical conditions and limitations. Once you begin the claims process, the insurance company will contact your doctors to confirm that you have the health conditions you are claiming, and they will want to see objective medical evidence of them. The better documented your conditions are by your doctor, the better your chances are that your LTD claim will be approved.
6. Experienced Legal Assistance Is Critical.
An experienced long-term disability attorney can help you file an LTD claim. You should never file an appeal of an LTD denial without speaking to an LTD attorney first. In particular, your attorney should be knowledgeable and experienced in handling ERISA (the Employment Retirement Security Act) LTD claims, which governs group LTD policies and the appeal process. Very few lawyers practice in this area, and there are special rules and procedures that you must be aware of. You need an ERISA-trained lawyer who understands the legal landscape and who can help guide you through this process. Relying on an HR rep or insurance adjuster to help you through the disability claims process is not good enough..
Contact Our Kansas City Long Term Disability Lawyer
Both the long and short-term disability claims process is long, difficult and full of landmines. There are many requirements that you must meet before your claim is approved, and what may seem like a small mistake can destroy your claim.
For more information on long-term disability appeals, download our free guidebook, Danger: Proceed at Your Own Risk, which explains the ERISA appeal process and shares tips on how to win your appeal.
If you have questions on the process or need assistance with a long-term disability claim or denial, please contact our office at 816-203-0143. If you have filed an LTD claim and received a denial letter, we will review your denial letter for free and provide you with guidance on what to do next.
Whatever you choose to do, you should act quickly as there are very short deadlines you must meet to file an appeal.