If you or a loved one cannot work due to a severe illness, injury, or medical condition, seeking long-term disability benefits from a private disability insurer may be in your (or your loved one's) best interest. Whether that coverage was purchased independently or provided through an employer, the Employee Retirement Income Security Act of 1974 (ERISA) protects your disability benefits and sets standards for those who manage your plan. The application process for long-term disability benefits may differ for each person, depending on the insurance company and whether you purchased insurance through your employer or independently.
Unfortunately, many insurance companies often deny long-term disability claims. If you submit a claim, your insurance company may distort the extent of your injuries, medical records, and the events leading up to the moment you filed the claim. All long-term disability insurance policies place the burden of proving a disability on the injured, not the disability insurance company. The disability insurance company will consistently evaluate your claim to determine if you still satisfy the definition of disability under the terms of your policy. They will request from you and review updated information regarding your claim and medical status.
Long-Term Disability Claim Process
In general, LTD claims must be decided within an acceptable period. Generally, if you submit a disability claim, then the plan must select within 45 days of receiving the claim. However, some circumstances could extend the timeline. Please here to determine when an extension is needed for your claim.
1. Reviewing information for your plan
When you enroll in an employer’s plan, you should receive a document called the Summary Plan Description (SPD). This document provides a detailed overview of how your plan works, what benefits it provides, how to file a claim, and any limitations that may apply to your case.
Before you apply for benefits, review your SPD to make sure you meet the plan’s requirements for disability and understand the filing process. If you do not have a copy of your plan’s Summary Plan Description or claims procedures, contact your plan’s administrator, who is required to provide you with a copy.
2. Request an application from your employee
Your employer’s Human Resources Department should be able to provide you with an LTD application. However, if your employee fails to provide you with the application or materials needed to fill it out, you can contact your insurance company directly to access the form.
3. Completing claimant’s statement form
All long-term disability insurance policies require you to provide the claimant’s individual statement form when you first file your claim and throughout your period of disability. While each long-term disability insurance company has its own unique form, they generally all follow the same pattern. These forms typically ask for general background information about you, your disability, treatment history, and your work performance requirements.
4. Requesting your employer’s statement
Every employer must complete an evaluation to illustrate how your disability has affected your job performance. Your employer must describe your role within the company, including your income and how your disability affects your capacity to do your job. If you've had to leave your job because of your disability, the employer will state the date you stopped working.
Your employer may also have to state whether you've filed for workers' compensation, social welfare benefits, and other long- or short-term disability insurance coverage.
What Medical Evidence Do I Need To Include in My Claim?
When filing a long-term disability claim, it is important that the medical records include accurate documentation of your physical or mental condition as a result of your disability. If the treatment records do not support the claim of disability, the insurer may deny the benefits. Insurance attorneys, as well as insurers handling these claims, require accurate medical review services to check the patient’s eligibility for LTD benefits.
1. Attending physician statement
All disability insurance companies ask your current physician to complete their Attending Physician Statement (APS) regularly. While each long-term disability insurance company has its own APS form, generally, they follow the same pattern and request similar information and opinions.
Your physician will be asked to identify your primary and secondary medical conditions that are"disabling" to you. Then, your physician will be asked to identify any restrictions and limitations which arise from your needs.
2. Objective medical evidence
Objective medical evidence is some form of diagnostic medical exam and tests. These procedures can establish fact-based evidence of a disability that prevents you from working, ultimately helping the success rate of your case. Unlike subjective evidence, a person's perception of their condition, objective evidence offers concrete and verifiable information to aid in assessing disability claims.
3. Treatment notes
It is important to obtain updated medical records from every treatment provider, not just your primary care physician. Prescription summaries from your pharmacy, diagnostic imaging, and hospital charts are also significant evidence that can help prove the case.
Do I Need a Disability Attorney?
It's never too early to hire an attorney to represent you in your disability case. As soon as you become unable to work, contact an LTD attorney to discuss how you should proceed. An attorney generally offers a free consultation or case evaluation over the phone or in person, so there's nothing to lose. A lawyer experienced with long-term disability claims will know how to abide by the ERISA standards and help you succeed in winning your claim.
At Expertise.com, we are committed to providing you with the best possible representation for the needs of your case. If you are seeking counsel from an experienced LTD lawyer, please click here to make an appointment with an attorney today.
1. LTD lawyers help you navigate complex regulations
It can be easy to make mistakes when you handle your long-term disability claim on your own. A common mistake can include failing to comprehend your policy and, most importantly, your definition of disability. If you do not fully understand your description of disability, you may not provide all the necessary evidence to satisfy the diagnosis, which often results in a claim denial.
2. LTD lawyers can hold your insurance company accountable
There are certain codes an insurance company must comply with under the terms of your policy or according to state or federal law. However, most claimants need to realize that insurance companies do not always follow these regulations.
3. LTD lawyers help you gather relevant evidence
Your attorney will make sure that your claim file contains all your relevant medical evidence and work with your physicians to obtain supportive opinions about your work-related limitations.
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