Long-Term Disability Elimination Periods: How Long Must You Wait?
If you are unable to work due to an illness, an injury or other chronic condition; time is of the essence. You need money to pay your medical bills and maintain your livelihood. Unfortunately, many individuals who purchased group long-term disability policies through their employer do not know that those policies often contain waiting periods—known as elimination periods. These periods are of the upmost importance as they must pass before you are eligible to receive long-term disability benefits under a group disability policy.
How Does My Long-Term Disability Policy Define an Elimination Period?
Under most group employer disability insurance plans, you must wait a certain period of time before you are eligible to receive long-term disability benefits. This waiting period is also known as an elimination period.
If you are applying for short-term disability benefits, your short-term disability policy will likely have an elimination period of between 0 and 14 days. However, the elimination period on a long-term disability policy may be as long as 90 or 180 days. To find out what elimination period is applicable to your claim, you need to obtain—and carefully read—a complete copy of your long-term disability policy.
The long-term disability plan document or summary plan description (SPD) should contain information that details what elimination or waiting period applies. The SPD and plan document are written in a technical way that may be difficult to decipher. If you have difficulty reading or understanding the terms of your policy, you should contact an experienced long-term disability insurance lawyer.
The Law Office of Kevin J. McManus would be happy to review your disability policy to help you understand your rights allowed under the terms and conditions. Our goal is to help you develop a strategy that will allow you to achieve your long-term and short-term needs.
Do I Need to Wait Until the Elimination Period Expires to Apply for Disability?
Many claimants believe that they cannot apply for long-term disability benefits until their policy's waiting period or elimination period expires. This is not correct. In fact, we often recommend that you apply for long-term disability benefits as soon as you meet the plan's definition of disability—even if you won't receive a check due to the elimination period.
This is because these claims take time. By not waiting, you will get your claim approved faster. Even if you aren't able to obtain benefits for the entire period in which you were disabled, you will obtain the maximum amount you're allowed under your policy by acting quickly.
Your disability claim must be reviewed and approved by the insurance company. If you are applying under a group policy, it is likely governed by ERISA. ERISA is a federal law that largely benefits insurers and gives them time and discretion to review and decide whether to grant claims.
Am I Entitled to Benefits After My Elimination Period Expires?
Unfortunately, long-term disability policies are very complicated. Most group long-term disability policies are governed by ERISA, which favors the insurance company. ERISA disability policies are written in a way to benefit the insurance company and discourage claims.
In addition to the elimination period, there are a number of other terms and conditions that may limit or prohibit your right to obtain relief. For example, you must prove that you meet the definition of disability under the terms of the policy. While this sounds simple to prove, each policy is different in how it defines disability and what you must establish to be entitled to benefits.
For example, are you disabled if you can't perform your "own occupation" or “any occupation”? Obviously, there is a big difference between these two situations, and ultimately the situation that applies in your case, depends on the language of your policy.
Does My Long-Term Disability Cover Preexisting Conditions?
Most long-term disability policies also provide limitations on preexisting conditions. For instance, many group long-term disability plans won't cover a condition if you reported symptoms in the 6 months prior to enrolling in the plan and file a claim within 12 months of enrollment. Other insurance policies may exclude or limit coverage for certain conditions such as mental illness, addiction or self-reported conditions or injuries.
Disability claims under ERISA disability policies that involve preexisting conditions can be tricky and difficult to navigate. Insurance companies will read those provisions of your policy broadly and attempt to use them to deny you coverage.
However, there are often situations where the policy is not clear or the insurance company claims a preexisting condition is present when that is simply not the case. In such situations, it is vital that you consult with an experienced long-term disability attorney. An attorney trained in ERISA will be able to interpret the policy provisions and help you understand your rights.
If you have received a denial letter based on an elimination/waiting period or a preexisting condition, please do not give up. If your policy is governed by ERISA you have the right to appeal such a decision, and if such appeal is denied, to file a case in federal court. Our long-term disability team is ready to assist you in understanding your rights under your long-term disability policy.
Contact Our Long-Term Disability Lawyer in Kansas City, Missouri
At the Law Office of Kevin J. McManus, we help claimants recover benefits they're entitled to under the law and would be happy to help guide you through the process. These claims have strict deadlines, so don't wait.
If you have received a denial letter for your disability claim, please send us your denial letter. We would be happy to review your denial letter for free and provide a strategy to fight back. Call us today at 816-203-0413 or fill out our online form and we can help you understand your rights and recover any benefits that you are owed.