By: Elliott Andalman, Esq., Attorney at Law: 301.563.6685
Long Term Disability (LTD) insurance policies imply that workers have the protection of disability insurance for a long time. Ideally, the benefits would last a lifetime. Unfortunately, disabled workers cannot count on these benefits long term.
First of all, these policies rarely pay for life.
Typically, the longest these benefits will pay is to retirement age as defined by the Social Security Act, which, depending on your year of birth, ranges from 66 to 67. However, there are exceptions. Some policies may pay longer, up to age 70. More problematic, some policies pay for only a set number of years. I have seen plans that pay benefits for a maximum of 3 years or five years. It is vitally important to know the exact terms and conditions of your policy.
The law grants workers the right to get a copy of LTD policies (often referred to as the “Plan” document). Typically, the policy is available for free from the employer. Make sure to obtain your Plan documents and carefully read them. Do not settle for a “Summary Plan.” That will not provide you the information you need.
Second, almost all LTD policies include a “Limited Pay Period” for some disabilities.
The vast majority limit the pay period for disabilities caused or contributed to by mental illness or alcohol and drug use. Typically these disabilities are limited to 24 months of benefits. Also, note that some of these policies will not apply the mental illness limitation to diagnoses such as dementia or schizophrenia. Again, you have to read the policy carefully to know the exact contours of this limitation.
Third, the LTD carriers have been adding other disabilities with a “Limited Pay Period.”
For example, some policies now have a limited pay period for “disabilities due to sickness or injury, which are primarily based on self-reported symptoms”. Typically, these disabilities are also limited to 24 months of benefits. Policies use different definitions of “Self-Reported Symptoms”. Here is a sample definition:
“the manifestations of your condition … are not verifiable using tests, procedures, or clinical examinations standardly accepted in the practice of medicine. Examples of self-reported symptoms include, but are not limited to headaches, pain, fatigue, stiffness, soreness, ringing in ears, dizziness, numbness, and loss of energy”.
You can see from this sample definition that the LTD carrier is trying to limit many disabilities to payment of only 24 months.
Fourth, the vast majority of LTD policies also limit benefits by changing the definition of disability.
Typically, an employee can go out on disability if they are disabled from performing their “own occupation.” Then, after some time, usually 24 months, the policy changes the definition of disability to “any occupation.” When the definition of disability changes to “any occupation,” all the LTD carriers will conduct a review of eligibility and may terminate benefits at that time.
Finally, LTD carriers all conduct periodic reviews, usually at least once a year, but sometimes every 3 to six months.
Those reviews typically include: (1) a form for the claimant to fill out about their current treatment, symptoms, and activities; and (2) an Attending Physician Statement (APS) for a treating physician to complete. The review may also include (3) collection of medical records; (4) ordering the claimant to be examined by a doctor that the carrier selects and pays for; and (5) a private investigator researching the claimant on the internet and recording the claimant’s activities outside of the home.
Unfortunately, the burden of proof in LTD claims is on the claimant to establish a disability at each review. So there is a risk at every review that payment of LTD benefits will end.
At any point in the process, from the initial application on, you have the right to representation by counsel. At Andalman & Flynn, we have been representing claimants on applications, reviews, terminations, and appeals for over 20 years. As experienced counsel in this area, we maximize your chances of winning and keeping Long Term Disability and other disability benefits.
Andalman & Flynn, P.C. serves clients throughout Maryland and the District of Columbia, offering compassionate, quality service and results-driven representation across a broad range of legal areas. With a concentration on disability benefits law and family law, the firm focuses on cases that impact the rights of everyone, and they are there for clients when responsive legal help is most critical. For more information about Andalman & Flynn, please visit our website or call 301.563.6685.