In 2022, the Center for American Progress examined data from the U.S. Bureau of Labor Statistics. They found that between 2020 and 2021, over 1.1 million Americans became disabled, and 65 percent were under 65. If you have recently become disabled and need to rely on your long-term disability insurance to cover your expenses while you recover, it is crucial that you understand the process ahead of you.
Learn about the different types of long-term disability insurance available to you, how the claims process works, and how a long-term disability lawyer at Frankel & Newfield, PC can help take on the burden of your claim while you focus on healing.
Long-term disability insurance (LTD) ensures an employee’s income against the risk of an injury or illness that keeps them from earning a paycheck. Long-term disability insurance is meant to replace a portion of a person’s income when they sustain a disabling injury, whether they are a highly-skilled professional, a blue-collar worker, or a manager. Anyone whose family depends upon their income should have long-term disability insurance. Many larger employers provide this insurance as part of an employee benefits package.
There are three primary types of long-term disability insurance policies. How we will handle your case depends upon the type and terms of your long-term disability policy. We represent claimants in New York and nationally with the following types of plans.
Most people get their long-term disability insurance through their employer as part of an employee benefits package that often includes health insurance, life insurance, and retirement benefits. Disability insurance companies sell disability policies to employers. They are known as “group” policies, as they are part of a group of employees with insurance. Often, employers pay these premiums, but sometimes, employees will pay all or a portion of the premiums for these benefits, or to add more coverage, when available. They are most often governed by ERISA, the federal Employee Retirement Income Security Act.
Some individuals purchase their own disability insurance directly with an insurance company because they are high-income earners or have a specific occupation, and the disability insurance provided by their employer would not be enough to maintain their family’s lifestyle if they could not work. These policies are known as “private” disability policies or “individual” policies and are generally more expensive than group policies.
Often, the rights afforded to a person with an individual policy are greater than those with a group policy. There are numerous distinctions between these coverages, covering many issues, including maximum benefit periods, limited conditions covered, and often the definition of disability.
People who belong to associations, like the American Dental Association or the American Association of Family Physicians, can often purchase disability insurance through their association that is more reasonably priced than private policies. However, they can often be more restrictive in the coverage provided. Most large national associations are affiliated with a large insurance company and provide disability insurance as a service to their members. There are also differences in coverage and rights between these policies, group policies, and individual policies.
Regular group disability insurance is the basic disability insurance provided by many employers for their employees, and coverage varies, but it usually covers about 60 percent of a person’s income. For highly-compensated employees, an additional layer of disability insurance coverage is known as a “group disability policy buy-up,” or enhanced long-term disability coverage. Companies typically offer disability buy-ups to individuals with very high earnings who need a larger percentage of their income protected. The employee usually pays for this coverage with regular deductions from their paychecks. This can often bring the total percentage of benefits to 70 percent of one’s income (although often with a monthly cap).
The qualification for long-term disability is less about what type of illness or injury the claimant has but more about the severity of the disability and their ability to perform the tasks required by their occupation. The focus of our support for a disability insurance claim is on the functional restrictions and limitations of a claimant. We have represented claimants suffering from a wide variety of illnesses, including but not limited to:
It is important to understand that when dealing with different disability plans and insurance carriers, each may use a different definition of disability when it comes to determining disability insurance benefits. What qualifies as a disability in one policy may not qualify in a second policy, depending upon a number of issues. Not all insurance plans cover the same range of medical conditions. Some plans also may note exclusions that preclude payment if certain actions caused the impairments. This is one reason it is so important to have legal advice and help from a qualified disability attorney.
Long-term disability coverage periods vary in length from six months to years. In most cases, long-term disability coverage lasts decades or until normal retirement age (or age 65). Every long-term disability policy is different and must be reviewed carefully to determine the coverage period.
Many disability policies limit coverage for certain conditions to 24 months. This usually includes mental health or psychiatric claims. Other illnesses, like headaches, chronic fatigue syndrome, and fibromyalgia, are limited in some, but not all, long-term disability insurance policies. Often the insurance company will seek to apply a limited benefit period, even when it is not in the contract.
The long-term disability claim process is very dependent on the terms of the policy. In some cases, a claimant must apply for short-term disability before they are permitted to file a claim for a long-term disability. In others, a waiting period, also known as an elimination period, must occur before a policyholder can become eligible for benefits, and thus it delays the time to file a claim. Speak with an experienced New York disability insurance lawyer before starting the claims process. There is simply too much at stake. We often advise claimants before the beginning of a claim to spot issues before they become problems. We work to “prevent the spill” to avoid having to “clean the mess.” Planning for the issues in advance often leads to the best outcomes in disability insurance claims.
Several reasons exist why insurance providers may deny long-term care in a disability case. These range from the definition of disability in group plans and individual policies to procedural errors by claimants. The following are some common reasons for denial of a long-term disability insurance claim:
It is essential to consult with a skilled long-term disability attorney who can review your case, identify the reasons for denial, and develop a strong appeal strategy.
Hiring an experienced long-term disability lawyer can be crucial to the success of your claim. A knowledgeable attorney can:
An experienced long-term disability attorney understands the complexities of disability insurance law and can provide you with the guidance and advocacy you need to navigate the process successfully.
Understanding the intricacies of long-term disability insurance is essential if you have recently become disabled and need to rely on your policy to cover your expenses. Each insurance policy is unique, and the claims process can be complex and challenging. By seeking the assistance of an experienced long-term disability lawyer, you can ensure that your rights are protected, and you have the best chance of securing the benefits you deserve.
Secrets the Disability Insurance Companies Don't Want You to Know!