Long-term disability (LTD) policies are generally covered by the Employee Retirement Income Security Act of 1974, a federal law often referred to simply as ERISA. LTD benefits provide financial stability if you are unable to work for an extended period of time, but the claims process can be difficult to navigate.
Review Your Policy Terms Carefully
Most LTD policies are designed to provide a percentage of your current income—typically 60 percent—if you become unable to work and are no longer receiving short-term disability (STD) benefits. However, there are often limitations on pre-existing conditions and mental health disabilities.
Every LTD policy has slightly different terms and conditions covering how benefits will be paid. Reviewing the policy documents carefully will increase your odds of successfully accessing benefits. If your LTD benefits are provided through your employer, the human resources staff can help you locate the appropriate documents. If your policy was purchased privately, you can call the insurer to request any information you don't already have on file.
Making note of any application deadlines is an essential part of the review process. Missing deadlines and incomplete paperwork are common reasons claims are denied.
Complete the Application and Gather Your Supporting Medical Evidence
As you're completing the application, provide as much information about your condition as possible while remaining truthful. Vague information or claims that speak about your limitations in absolute terms will likely trigger a denial.
Medical evidence is essential to support a claim for LTD benefits. Inform your doctor that you wish to apply for LTD benefits and ask him or her to write a letter describing how your impairment affects your ability to work. A written letter from your doctor is more helpful than simply completing the forms from your insurance company, as these documents are designed to collect information that can be easily used to deny your claim.
Request copies of all of your medical records—including clinical notes, exam reports, lab work, and test results. Make sure you have completed every recommended test or procedure that your care providers believe is appropriate for your condition, since a history of inconsistent medical treatment can be used to argue that your disability is not severe enough to qualify for benefits.
As you are completing the initial application, it is also a good idea to write down your own version of your job description and compare it to what your employer states the position involves. Often, especially at smaller companies, an employee's duties will evolve to include more tasks than he or she was originally hired to perform.
Communicating With the Claims Adjuster
After your application has been submitted, you will be contacted by a claims adjuster who will request additional information or documentation. For example, if you have already applied for Social Security disability benefits, the adjuster may want to know the status of this application.
Note that it is becoming increasingly common for insurers to use video surveillance and unannounced home visits to cast doubt on the severity of a claimant's disability. If you are observed doing an activity that you have claimed you are unable to perform, such as walking long distances or lifting more than 20 pounds, this can invalidate your application.
When in Doubt, Consult an Attorney
Receiving LTD benefits can be a time-consuming and complex process. If you do not understand how to appropriately document your condition or disability, it can make it difficult to complete all of the necessary paperwork. A skilled attorney familiar with ERISA law can help.
If your application is initially denied, an attorney can assist you in preparing an effective appeal. In most cases, your insurer will give you 180 days from the date of denial to submit an appeal. If you miss the appeal deadline, you lose the right to sue the insurer in federal court since you did not exhaust all of your allotted administrative appeals. Depending on the terms of your policy, you are typically allotted one or two administrative appeals before gaining the right to sue in federal court.
The dedicated legal team at Gibbons Leis, PLLC has extensive experience handling LTD claims and appeals. Call today to schedule a free case evaluation.