We help disability claimants receive the long-term disability (LTD) insurance benefits they are entitled to receive. If you have been denied benefits, we can help prepare and file your administrative appeal with the insurance company in an effort to maximize the chances that your LTD claim will be approved. If your benefits have been cut-off or terminated, we can help prepare the appeal to have your benefits reinstated. If you have exhausted your administrative appeals with the insurance company, we may be able to file a lawsuit against the insurance company.
Here’s a basic introduction to how Long Term Disability Insurance claims work.
ERISA Long Term Disability insurance claims are complicated. They involve short deadlines and are governed by complex federal laws and regulations.
A collection of common words and phrases you’ll find in most long term disability policies.
Both IDI and GDI disability programs offer cash benefits for disabled individuals, but the remedies available to claimants (if the claim is denied) are very different.
An overview of the long-term disability evaluation process and what you need to do to get benefits. Includes for medical eligibility for disability benefits.
The basics of how LTD insurance companies process and decide a disability claim.
How many disability claims are filed with Long Term Disability insurance companies? How many win benefits? How does it work?
If you’ve paid premiums and have coverage under a long term disability insurance policy and you become unable to work, the insurance company will pay you a percentage of the salary or wages that you earned before becoming disabled.
If you have coverage under a long-term disability insurance policy and you’re unable to work due to one or more disabilities, you may be eligible for long-term disability insurance benefits to replace some of your lost income.
In California, employer-funded disability insurance policies (as well as those paid by the employee as part of a group plan benefit with the employer) may provide short-term disability benefits and long-term disability benefits.
Here we break down the language of a typical long term disability policy.
Insurance policies are designed in a way that will maximize the insurance company’s ability to deny your claim.
For the purpose of this article, we’re classifying government employees as anyone who works for a municipality, state, or the United States federal government.
At the end of the day, a long term disability claim is governed by a contract. The contract is your policy.
Long Term Disability Lawyers
To help you “level the playing field” against a large insurer who has much more knowledge and experience in the world of disability law, it makes sense to hire an experienced disability lawyer.
How much a long-term disability lawyer charges depends on your attorney-client fee agreement and how much the insurance company ultimately pays you (if anything).
Having an experienced attorney handle your Long Term Disability insurance case may help to speed up the very long process.
If your benefits have been denied or cut-off, hiring a disability lawyer can definitely help.
If you have a long-term disability insurance policy, either an individual policy or group plan benefit, you may be eligible to continue receiving a percentage of your salary in the event you become unable to work due to a disability.
There may be some qualifying requirements to be eligible for long term disability insurance benefits, such as being a “full time” employee.
The differences between own occupation and any occupation can be technical and confusing. In this article, we will break down the differences “own occupation” and “any occupation.”
As part of the claims process in reviewing your claim, the insurance company adjuster may want to schedule a “sworn statement” (sometimes called a recorded statement) with you. The statement may be arranged to take place on the phone or in-person via a “field visit”.
For long-term disability insurance purposes, to be considered disabled, a person must have an impairment – either medical, psychological, or psychiatric in nature – that keeps the person from working.
Your age may play a significant role in determining whether your claim for Long Term disability benefits is approved.
In terms of qualifying for disability insurance benefits, the issue is whether your disability began before you are terminated. That being said, if you are fired while on disability leave, you may have a separate employment claim for wrongful termination.
If you’re receiving LTD benefits, keep in mind that your insurance company reviews most claims month-to-month and can terminate your monthly payments for any number of reasons.
The idea is they don’t want to cover you for something that you’ve been getting treatment for if you go out on disability within a year of starting your job.
To qualify for long term disability insurance benefits, you must prove you have a severe, medically determinable impairment that limits your functioning to such an extent that you aren’t able to work in your own occupation, or any occupation, depending on how your insurance policy defines the term “disability”. An insurance adjuster analyzes each disability claim for the insurance company.
The Basics of Medical Eligibility for Disability Benefits
Long Term Disability insurance pays monthly benefits to insured employees who become unable to perform the duties of their job for medical reasons.
There are many ways you can provide evidence that your illness or condition qualifies for long term disability insurance benefits.
Some applicants continue to receive disability benefits even after their medical condition improves.
You don’t have to be disabled for any length of time before you apply for long-term disability benefits, but there is typically a 90 to 180 day waiting period to receive LTD payments.
Factors That Can Affect Disability Eligibility
Most people understand that medical evidence is essential in a long term disability claim, but sometimes the importance of the treating physician(s) is overlooked.
A treating physician is a medical doctor who provides medical treatment for you and has, or has had in the past, an ongoing relationship with you. There needs to be a history of treatment between the medical provider and the patient for the medical provider to be considered a treating physician
An important factor in your claim for long-term disability insurance benefits is your credibility. This is especially true if part of the reason you can’t work is due to pain or if you suffer from a mental illness because these conditions are difficult to measure with objective medical tests (like blood tests, X-Rays or MRIs.)
If you’re filing for disability benefits and don’t seek treatment for your impairment or don’t follow your doctor’s orders, your credibility will be in question.
The insurance company must take your pain into account as long as you’ve been diagnosed with a physical or mental impairment, including fibromyalgia.
If you have a physical impairment that could be improved by surgery but you refuse to have the operation, you may be barred from receiving LTD benefits. Your insurance policy likely has a specific clause relating to this issue.
Tips on Medical Eligibility From Disability Lawyers
Your physical RFC will determine whether you can perform sedentary, light, medium or heavy-duty work.
Your mental RFC will determine whether you can perform work-related mental activities.
The Long Term Disability Benefits process is frustrating for most people. You have to fill out numerous forms, talk to numerous people about your disability, and more. This guide helps you avoid ten common pitfalls in disability insurance claims.
Getting long-term disability benefits is not easy unless you have an extremely severe physical or mental impairment. Most people who apply for LTD benefits are denied because the insurance company believes the claimant can return to his or her own occupation, or because the insurance company believes re is some other type of job the claimant can do. It can help your chances of getting benefits to learn about how the disability review process works, and learn tips to improve your chances of winning.
Your Chances of Winning LTD Benefits
This is an impossible question to answer with certainty because of the number of factors that go into the decision, but the following is based on our firm’s own experience.
Here are some tactics long term disability companies use to trick you or otherwise try to avoid paying out benefits
The medical diagnosis or name of your condition alone won’t win disability for you. Here are the factors that matter.
No. Insurance Companies approve many claims at the initial application stage. However, many claims are prematurely terminated or cut-off.
There’s really no way to know what your chances will be when you file an appeal as each claim is as unique as the person making the claim, other than the fact that your chances will generally improve the stronger you build your case.
This type of video is useful because it humanizes you. It allows the adjuster who’s reviewing your case to see the exact impact that your condition is having on your life.
When you go to cour there is a six-step process, the most important of which are the first three. When you look through the first three steps, you’re going to see why it is so difficult to win a long-term disability claim.
Please note that because every claim is unique, this list of “Do’s and Don’ts” is not an exhaustive list. It is merely to serve as a reminder of the most important things you should and should not do in an appeal.
Unhelpful or inaccurate statements on your application or in your medical records can be harmful to your Long Term Disability Insurance claim.
If you are denied on your LTD benefits claim, you should request an appeal immediately, within the deadline set out in your disability policy or in your denial letter (typically 90 or 180 days).
An LTD denial doesn’t necessarily mean you’re not disabled — look at your denial notice to see the specific rationale for the denial in your individual claim.
A technical denial of Long Term Disability benefits occurs when an applicant does not meet the non-medical requirements to qualify for LTD benefits.
Learn about common reasons cited by insurance companies as to why they are denying long term disability benefits.
The doctrine of “bad faith” only applies to state law claims against an insurance company based on the company’s conduct in handling a claim for individual disability insurance benefits.
The primary reason why benefits are cut off after two years is that under most policies, not every policy, but most policies, there’s a change in the way that they’ve defined the term disability.
Disability Appeals Process: Overview
Most people, when they file an appeal, it’s really basic. We’re talking a one or two paragraph appeal. Now, that is wholly insufficient.
All LTD policies provide for at least one level of administrative appeals. In fact, many have two levels of appeal. Many workers eventually receive their benefits only after winning a claim on appeal from a denial.
There are typically several levels of appeal that are offered to Long Term Disability claimants after a denial or termination of benefits.
Too many claimants make the critical mistake of not even filing an appeal after they’ve been denied their disability benefits or after their benefits have been terminated.
Do I just send the Insurance Company a handwritten letter that I want to appeal the denial of my long-term disability benefits?
Here’s a timeline for how long a long term disability appeal with an insurance company might take.
If your initial application for Long Term disability benefits has been denied or if your benefits have been cut-off too soon, it may be a good time to talk to a lawyer.
These advanced strategies can be expensive and are not used in every case, but can be highly effective in select cases.
If you’re denied Long Term disability insurance benefits by the insurance company, you may be eligible to file a lawsuit in federal court.
The insurance company may have the file reviewed by a “peer review” physician, who will likely issue a report questioning any opinions issued by your own treating physicians.
The insurance company may have you examined by an “Independent” doctor. The word independent is in quotes as we do not believe most of these physicians are really independent. We prefer to call these exams “Compulsory Medical Examinations.”
The insurance company may have a vocational expert/consultant (a job expert), review your file and issue opinions as to whether you can perform work activity given restrictions identified by doctors in the file.
Long term disability companies are well-known for hiring third-party investigators to put claimants under surveillance.
During a long term disability case, it is common for the insurance investigator to request a “field interview”. Field Interviews are used to discredit claimants filing for disability.
In this article, we are going to discuss the field interview requests that commonly come from long-term disability insurance companies and what to do during a field interview.
Long term disability companies can use your social media accounts against you.
Buyout offers are made by the insurance company while you are receiving long-term disability benefits. Settlement offers occur when you’ve been completely denied benefits and you’re trying to negotiate a settlement with the insurance company either right before filing a lawsuit or after filing a lawsuit.
The United States courts of appeals (or circuit courts) are the intermediate appellate courts of the United States federal court system. That means they are the level between federal district courts and the Supreme Court of the United States. A court of appeals decides appeals from the district courts within the states in its federal judicial circuit.
The United States Court of Appeals for the Eleventh Circuit is a federal court with appellate jurisdiction (authority to hear appeals) from district courts in Florida, Alabama, and Georgia.