Whether you have a long-term disability plan through your employer or purchased one individually, you should be able to continue collecting a portion of your salary if you become unable to work. But what are long-term disability requirements for benefits eligibility? What hurdles do you have to clear in order to receive benefits?
If you are considering filing an LTD claim, you should look at the summary plan description for your long-term disability policy. If you don’t have one, ask for one from your human resources department or the insurance company if you have an individual plan.
The plan should outline a precise definition of “disability.” In order to be found “totally disabled” by your LTD insurance company, you must be unable to substantially perform the duties of your occupation due to illness or injury. Some plans allow for LTD qualification for “partial disability” if you are no longer able to work full-time in your own occupation, even though you may be able to work part- or full-time in another job. However, if you are still on your company’s payroll, it is unlikely that you will be able to obtain LTD benefits.
The most important pieces of evidence in your LTD claim are statements from your treating physician. Your doctor will get a request to complete a form as part of your LTD application process. This statement will include their opinion about your condition. Your doctor’s records and opinion are critical. This includes clinic notes, lab results, x-rays, MRIs, exam findings, and other tests and reports.
Since your disability is ongoing, you should continue going to the doctor even while your LTD application is pending. You can send updated records to the LTD insurance company as they are considering your claim. If you do not continue treatment even after your claim is approved, the insurance company may stop your benefits.
If you have an individual plan, then you must be current on your premiums before you make a claim. However, many people have free coverage through their employers and do not make payments.
Most LTD parties have a waiting period, sometimes called an “elimination period,” which requires you to wait a period of time between when the disability occurs and when you start receiving benefits.
Waiting periods are often as long as three to six months; however, they usually coincide with the length of time your short term disability covers. You will also likely be required to use all of your sick leave from work before filing for short-term disability. And, you will be required to exhaust all of your short-term disability before obtaining long term disability.
Many LTD policies have exclusions for pre-existing conditions. A pre-existing condition is an illness or injury that has been diagnosed or treated within a certain period before your LTD coverage began. If you have a pre-existing condition, your LTD insurance company may deny your benefits within the first twelve months of coverage.
Some conditions are not covered by LTD policies at all. These exclusions may be related to particular diseases or specific types of workplace accidents. Some LTD policies also have 24-month limits on disabilities caused by alcohol, drugs, mental or nervous conditions.
Once you’ve been approved for LTD benefits, you will likely be required to file for SSD benefits as well. The LTD insurance company will be able to offset any amount you receive from SSD against your LTD payments. Thus, it benefits them if you are approved for SSD. An LTD insurance company may even hire a disability attorney to help represent you in your SSD case.
If you were injured on the job and you are receiving LTD benefits as a result, you will also likely be required to file for workers’ compensation benefits. Like SSD, any workers’ comp payments you receive will offset your LTD benefits. If you want to continue receiving LTD benefits, you must work with your insurance company and apply for SSD or workers’ comp benefits.
LTD claims can be complicated, especially when you’re not sure if you meet all of the requirements to receive benefits. For help with your claim or to learn more about long-term disability requirements, call a disability attorney at CJ Henry Law Firm PLLC today.
