By Peter Casciano, Esq.
As national LTD attorneys based in the DC metro area, we’ve had many experiences helping all types of clients navigate through the disability application and benefits system. In that time, we’ve found that many applicants have similar questions about long term disability insurance coverage and the process for applying for LTD benefits. We can provide you with more personalized assistance during your consultation, but we’ve compiled a list of frequently asked long term disability questions to provide you with a basic understanding before seeking legal action.
Our List of Long Term Disability Questions & Answers Includes:
I never purchased long term disability (LTD) benefits. How do I know if I am eligible? What are the long term disability qualifications?
Many private companies purchased long term disability insurance coverage for their employees at no cost to them. Generally, employees are notified of this coverage when they are offered the job, but because of the many administrative and logistical challenges associated with starting a new job, LTD benefits sometimes get lost in the shuffle. Even if you are positive that you do not have LTD coverage, it’s always a good idea to ask your Human Resources (HR) department for confirmation.
Must I file for short term disability (STD) before filing for LTD benefits?
LTD policies generally contain an elimination period that excludes a claimant from obtaining benefits. The elimination period requires that the claimant prove disability without receipt of benefits for the first 90 to 180 days, depending on the policy. STD is designed to cover the elimination period of an LTD policy. Therefore, if your LTD elimination period is six months, your STD benefit should run for six months as well. LTD carriers generally require that you at least apply for STD benefits. Doing so certainly makes the process run more smoothly.
If I never signed an LTD contract with the insurance carrier, why am I bound to the terms of the policy?
This question is the source of a lot of frustration for our clients. Especially due to the fact that the LTD policy often contains clauses that require applicants:
(1) to see the insurance company’s doctor;
(2) to complete and remit frequent update forms (also required of the doctor); and
(3) repay money due to the receipt of other funds.
Why do I now owe money to the insurance company after I was approved for LTD benefits?
This can happen if you are approved for Social Security Disability (SSD) benefits after being approved for LTD benefits. Typically the Social Security Administration (SSA) takes longer to approve your case than an LTD carrier and when you are approved, you are often approved retroactively to an earlier date. Those “back benefits” that you receive from the SSA are generally “offset” by the LTD benefit—meaning you owe those funds back due to a clause in the LTD policy.
I think the insurance company hired a private investigator to follow me. Is that allowed?
Unfortunately, yes. When you submit your application for LTD benefits, you are also agreeing to be a subject of the insurance company’s surveillance. This typically happens when our clients allege a physical illness or state that they very rarely leave their home. If you notice suspicious behavior and think you are being investigated, our advice is to act normal and do exactly what you normally do. I have oftentimes turned an insurance company’s video around on them to prove disability.
My insurance company notified me that I am in a review period. What should I do?
You should definitely consider hiring an LTD attorney because the insurance company will be gathering as much information about you as possible. This is the time when:
- Surveillance occurs
- In-home interviews are performed
- Independent Medical Exams are scheduled
- Updated forms must be completed by you and your doctors
Simply because your condition hasn’t changed does not mean that the review period will go smoothly or end successfully. An experienced disability attorney can help you navigate this challenging time and act as a buffer between you and the insurance company to ensure you receive a full and fair review.
How long do I have to appeal a denial or termination of my LTD benefits?
If you are applying for LTD benefits under a policy purchased for you by your employer, called a group LTD policy, then you are afforded protection under the federal Employee Retirement Income Security Act (ERISA) statute. The ERISA statute requires that claimants have 180 days to appeal adverse decisions by the LTD company. You may ask for more time if needed, but the insurance companies are not required to oblige with your request.
Will my policy’s definition of disability always remain the same?
Typically, no. Most group insurance policies change the definition of disability from “unable to perform your previous occupation” to “unable to perform any occupation” after you receive 24 months of LTD benefits. This change in definition is critical to your case and your doctors must be aware of this when providing updated forms for the insurance company. A frank discussion between you and your doctor at the 24 month deadline is also important so that you can obtain any objective tests necessary for the doctor to form an opinion using the tough “any occupation” definition.
Are all LTD benefits calculated the same way?
No, you must obtain a copy of the specific policy to see how long term disability insurance coverage is calculated. A common method of calculating LTD benefits is to begin with 60 or 66.66 percent of your pre-disability salary and then reduce that number by any other income you may be receiving. That income could come from other disability benefits, pensions, or work.
Have More Long Term Disability Questions? Contact Us for a Consultation.
If you need further explanation or have other long term disability questions not covered here, we can help. We can also provide legal representation to those applying for LTD benefits, whether you are located nearby in Maryland or across the country in San Diego or Seattle. To speak with me about your questions or see if you are eligible to apply for long term disability insurance coverage, please call or email me at: