Long-term disability is a form of insurance with the primary aim of providing income replacement if an individual is unable to work for a period of three months or longer. These policies allow those eligible to continue receiving an income (typically on a monthly basis) up to a predetermined period of time.
The terms of the disability benefits available will differ depending on:
- The insurance company you use
- The long-term disability coverage you take out
- Your premium payable
Most long-term disability policies will pay out between 60 percent and 85 percent of your previous salary. Disability insurance is primarily designed to protect—and in most cases replace—your income in the event you become disabled and unable to continue working. Applying for these benefits ensures you receive the necessary financial support required to maintain your current lifestyle.
Understanding Long-Term Disability Insurance
Long-term disability insurance offers eligible individuals a monthly benefit payment that replaces some or all of their lost income. The aim is to help cover essential expenses while they are unable to work, and often help continue health insurance in order to minimize out-of-pocket medical expenses.
To be considered for long-term disability insurance, the insurance company must first determine eligibility. The typical criteria include the following:
- Qualifying condition: You must have medical conditions, injuries, or illnesses that prevent you from performing your current jobs or any other occupation.
- Waiting period: You may need to complete a waiting period, also known as an elimination period, before becoming eligible for benefits.
- Diminished capacity: Long-term disability coverage has two main categories of coverage.
Long-term disability insurance typically covers a wide range of disabilities, including, but not limited to:
- Musculoskeletal disorders
- Special senses and speech
- Respiratory disorders
- Cardiovascular system
- Digestive system
- Genitourinary disorders
- Hematological disorders
- Skin disorders
- Endocrine disorders
- Congenital disorders that affect multiple body symptoms
- Neurological disorders
- Immune system disorders
The list of covered disabilities will vary depending on the specific insurance company and policies available. Before filing a claim, it’s important to have a strong understanding of your long-term disability insurance.
Gathering Essential Documentation
After contacting your insurance company, the necessary claims forms will be provided to you. Generally, these forms will require you to fill out information about your medical condition, employment history, and supporting documentation. It’s important to take the time to fill these forms out correctly, making sure all the essential details are present.
In some cases, an employee’s statement may need to be submitted. You can also ask the HR department to submit an employer statement on your behalf. Proper filing for long-term disability benefits requires you to pay close attention to detail and ensure the necessary forms are submitted in a timely manner.
An application package for long-term disability benefits usually consists of three separate documents:
- One for you to complete
- One for your employer to complete
- One for your doctor to complete
Having all this paperwork in order before reaching back out to the insurance company is crucial to receiving the most beneficial results possible. Working with a long-term disability lawyer can make this process easier, and ensure all the necessary documents are submitted on time.
Know Your Policy
In most cases, it is important to read your entire policy in order to understand the precise wording and expectations. The technical jargon throughout these documents will outline the pre-existing exclusions, exceptions to exclusions, all source maximums, direct offsets, and indirect offsets covered within the insurance.
Long-term disability benefits can end for a number of reasons, all of which are outlined within the policy. These can include:
- Recovery from injury
- Retirement
- Death
- Becoming 65 years old
- Failing to submit proof of ongoing disability
- Being in prison
- Refusing to attend a medical examination
- Failing to participate in a designated rehabilitation program
Every long-term disability claim is different, and the process by which you apply and receive benefits can vary depending on your specific circumstances.
Seek Legal and Medical Advice
Long-term disability insurance covers a wide range of medical conditions, most of which are related to physical injuries. That said, some policies can also cover mental injuries. To receive the proper diagnosis, it is essential for anyone suffering from an injury to see the necessary medical professionals, whether that is for rehabilitation or treatment.
Demonstrating you are seeking reasonable treatment and are under the specific care appropriate for your condition can be a requirement for receiving insurance benefits. This also includes showing compliance with any medications that are prescribed for your condition.
Having a claim approved depends on a number of factors, including:
- How your insurance policy defines “disability”.
- The type of disability insurance policy that is available.
- The type of disability you are suffering from, with regards to your ability to perform the regular duties of your job.
- The frequency with which you see your doctor.
- The frequency with which you seek treatment.
A long-term disability lawyer can help you understand the technical jargon associated with a given policy, and ensure you receive the most benefits possible. Applying for long-term disability insurance can be a difficult and complex process. Working with a lawyer who has the expertise and legal knowledge necessary to successfully file a claim can make the entire process smoother.
Filling Out the Application
Once you have established eligibility for a long-term disability insurance claim, you must complete an application. These applications typically include a series of forms, such as a plan member statement, an attending physician’s statement, a plan sponsor statement, and a job description. These forms are meant to:
- Ascertain details about your claim.
- Receive authorization to communicate with your lawyer or doctor.
- Get authorization to access medical information about you.
- Obtain information about your duties and responsibilities at work.
- Navigating the Review Process
After submitting a long-term disability claim, your insurance company will initiate the initial review and evaluation process. At this stage in the process, the claims department takes time to carefully assess your provided information.
This initial review aims to determine if your case meets the basic eligibility requirements for long-term disability benefits. These criteria are outlined in the policy agreement, along with the insurance company’s specific definition of “disability”.
The evaluation will ultimately establish if your medical condition prevents you from performing your job effectively, and if it qualifies as a disability under the terms of your policy.
Appeals and Denials
If for some reason your application is denied, it is within your right to ask the insurance company to reconsider. This is accomplished through an appeals process, which can look different for every case.
An effective appeal needs to be approached strategically to maximize the chances for success. Working with a long-term disability lawyer can ensure you receive the best possible outcome.
Making a Long-Term Disability Claim
Most long-term disability benefits become available once either short-term disability benefits or employment insurance are no longer available. The purpose of these three benefits is to protect your income should you lose the ability to work due to an injury or disability.
Disability insurance can be purchased on an individual basis, or an employer may provide it as a worker benefit. To understand the full extent of coverage you have, and what claims you could potentially make, be sure to review the complete available policy.
