Becoming disabled can strip you of your ability to make a living. While some people can use their savings to get by, very few people can afford to stop working altogether for a prolonged amount of time.
This is where long-term disability insurance comes into play. Long-term disability policies provide you with a steady income for an extended period of time. Most people who have long-term disability insurance are able to purchase it through their employer. However, you can buy individual long-term disability insurance on your own. Additionally, if you have long-term coverage from an employer, the payouts are usually not enough to cover your needs until you can return to work.
How it Works:
When you buy a long-term disability insurance policy, you pay premiums (usually between 1% to 3% of your salary) to be covered if you become disabled. If you become disabled and meet your policy’s definition of disabled (this will vary by policy), then you are eligible to receive benefits after a waiting period (also called an elimination period). Benefits are usually about 60% of your gross income. They can last anywhere from 2 years until retirement age, depending on the terms of your policy.
What Conditions Qualify:
Most people think that long term disability is for those who have been physically injured in an accident and unable to work due to their injury.
While this is true, it’s essential to know that many medical conditions may entitle you to receive disability payments from your insurer. These include neurological disorders, chronic illnesses and certain degenerative diseases.
Some of the conditions that may qualify you for long term disability benefits include, but are not limited to:
- Cancer
- Bipolar Disorder
- HIV/AIDS
- Crohn’s Disease
- Lupus
- Chronic Fatigue Syndrome
- Degenerative Disc Disease
- Fibromyalgia
- Multiple Sclerosis (MS)
Ultimately, it’s the insurance company’s job to determine eligibility for long-term disability benefits under your policy terms. The above list of medical conditions is not exhaustive and differ from policy to policy. Before filing your long-term disability claim, it’s essential to understand how your insurance company defines disability.
Length of Benefits:
Most long-term disability insurance policies payout for two, five, or ten years or until retirement. Long-term disability policies contain a Maximum Benefit Period (also known as Maximum Indemnity Period or Maximum Duration). This period determines how long your LTD benefits will last.
Denied Long Term Disability?
Sometimes, the insurer will decline your application. In other cases, the insurer will cover you only if you agree to a modification of your coverage, which could mean accepting some limitations on your coverage without a resulting premium discount. The reasons you may be denied long-term disability coverage are usually based on one or more of the factors below:
- You don’t meet your policy’s definition of disabled
- You have an excluded or pre-existing condition
- Your insurance company is missing medical records
- You have insufficient evidence documenting your disability
- Your claim is based on “self-reported” symptoms
- Your insurance company’s doctors disagree with your physician
- You are caught performing activities that your disability should prevent you from doing
If the claim is denied, an individual should seek the advice and counsel of an attorney experienced in long-term disability cases. This is because the appeal process is fraught with traps and pitfalls. The single most crucial pitfall is the failure to develop the administrative record during the appeal process, which can be irreparably harmful for future litigation if not prepared properly.
Daggett Shuler Can Help You with Your LTD Case!
Insurance companies are powerful, have a lot of resources, and are motivated by their financial interests. At Daggett Shuler, we’ll take on the burden of dealing with the insurance company for you, so you can focus on your health. Our attorneys can answer your questions regarding long-term disability such as how it works, doctors, long-term disability appeal and litigation.
If you or a loved one need help to apply for disability benefits, were wrongfully delayed or denied your disability insurance benefits, or are seeking to litigate after an administrative group appeal, call us at 336-724-1234 today.
Daggett Shuler – You Can Depend on Us.