By Matthew DeGioia, 301.563.6685
Many employees receive an ERISA Long Term Disability insurance policy as a part of their employee benefit plan, but they don’t know much of what they are entitled to or what the application process entails. This blog post serves to dispel much of the misinformation that has circulated regarding these claims.
Myth #1: “I don’t need Long Term Disability Insurance coverage.”
You may think that you can rely on worker’s compensation or Social Security Disability Insurance benefits to provide enough of a safety net in the event you sustain an injury or illness that prevents you from working at your job. However, there is no guarantee that you will prevail on either of these claims, as each of these claims can be very difficult to win. In addition, the wait for a decision on either of these claims can take anywhere from three to five months, to over two years depending on the complexity of your case. You want to ensure that you are covered in the event you are no longer able to earn wages, and a Long Term Disability Insurance policy can provide you with some peace of mind as you become disabled to work.
Myth #2: “I can’t get Long Term Disability Insurance coverage if I am a federal employee.”
If you are a federal employee enrolled in a Federal Employees Retirement System (FERS) plan, you can still purchase supplemental Long Term Disability Insurance coverage in addition to your FERS benefit plan. You should note, however, that by participating in FERS your insurance coverage may be significantly limited, as insurance carriers equate government employees as having 40-60% of group plans.
Myth #3: “If I do everything the insurance carrier says, I will be treated fairly and will be awarded benefits.”
Unfortunately, pursuing a Long Term Disability claim in good faith does not necessarily mean that you will prevail on your claim. Insurance carriers have an interest in denying your claim. Therefore, it is important for you to have counsel who can guide you through the process to ensure that the carrier is not violating their duties towards you as an insured.
Myth #4: “If my claim is denied, I should file the appeal immediately.”
When appealing a decision, it is best to hold off on filing the appeal until you have all of your medical evidence assembled for the insurance company’s review. This includes any independent examinations or objective testing performed by experts to address deficiencies in your claim identified by the carrier on the initial denial decision. If the carrier denies your claim a second time, you would need to file a complaint in federal court, which will only review the evidence and arguments filed on the administrative level. Generally, the Court will not consider any new evidence. This is why it is critical for you to retain an attorney when you are first denied to assist you in assembling the medical documentation and preparing argument in support of your appeal.
Myth #5: “I should win Long Term Disability benefits because I won Social Security Disability benefits.”
While a Social Security Disability award is significant, an insurance carrier is not bound by the Social Security Administration’s decision to find you disabled. The Social Security Administration uses different definitions of disability, which can vary depending on a claimant’s age, education, training, past work, and transferable skills.
Myth #6: “If my treating doctor says that I am disabled to work, I should be able to win Long Term Disability benefits.”
While having support from your treating physician is imperative for any Long Term Disability claim, an insurance carrier does not have to defer to the medical opinion of your treating physician. Your physician’s medical opinion must be supported by objective clinical findings and be corroborated by the evidence of record. In some cases, it may be necessary for you to undergo an independent evaluation by an expert to document more subjective findings of pain, fatigue, cognitive decline, or executive dysfunction, and to have that evaluation corroborated by your treating doctor. Given the interest that the insurance carrier has in denying cases, a victory is not a guarantee.
Myth #7: Mental or cognitive impairments are treated as any other disability under a Long Term Disability policy.
Most Long Term Disability policies limit payment of benefits to 24 months for claimants alleging disability caused or contributed by mental illness or “self-reported symptoms” such as cognitive impairment, chronic pain, and fatigue.
Myth #8: If I cannot perform my current job, but can perform other work, I should still be entitled to Long Term Disability benefits.
Most Long Term Disability policies will pay benefits to you if you prove that you are unable to perform the material duties of your current occupation. However, upon receiving benefits for 12-24 months, the definition of disability will likely change, requiring you to prove that you are unable to perform the duties of any gainful occupation for which you are reasonably fitted by education, training or experience.
Winning and keeping Long Term Disability benefits is not simple. We strongly recommend that you obtain experienced counsel to assist you through this process. At Andalman & Flynn, we have helped workers successfully through this process for over 20 years. We know how to maximize your chances of winning.
About Andalman & Flynn, P.C.: Founded in 1998 in downtown Silver Spring, Maryland, Andalman & Flynn has forged a distinguished reputation for legal excellence. The firm represents individuals seeking disability benefits throughout the country and practices family law throughout Maryland and the District of Columbia. The firm focuses on cases that impact the rights of everyone, and are there for clients when responsive legal help is most critical. The firm has provided legal analysis on national and local television and radio, and their attorneys often testify before legislative bodies and are routinely invited to contribute to prominent legal publications. For more information about Andalman & Flynn, please visit the website at andalmanflynn.com or call 301.563.6685