Table of Contents
- Meet the Insurance Company’s Idea of Disabled
- Keep Your Policy in Good Standing
- Meet the Requirement of a Full-time Employee
- Be Patient
- Get a Doctor’s Evaluation
- File for Social Security Disability
- File for Worker’s Compensation
- Beware of Exclusions to Your Long-Term Disability Insurance
- Hire an Experienced Disability Attorney
- Keep Reading
More than 25% of young people now entering the workforce will at some point during their career experience a disabling condition that will keep them from working for a minimum of a year. If that should happen to you, are you prepared to file a claim for long-term disability insurance?
Let’s take a look at the key requirements for getting your long-term disability claim approved.
Meet the Insurance Company’s Idea of Disabled
The first step to filing for long-term disability is to consult your disability policy. You need to know the specific definition the insurance company uses for long-term disability.
If your long-term disability policy is through your employer, you can ask the Human Resources Department for the definition. However, if you purchased an individual policy, you should be able to find the definition in the policy’s description of the insurance plan.
Typically, an insurance company considers a person disabled if they have developed a medical condition or sustained an injury that makes them incapable of continuing to perform their job satisfactorily.
Keep Your Policy in Good Standing
If you purchased your long-term disability policy independently of your employer, it’s your responsibility to make sure the policy remains in good standing. Keep your payments current. Once you begin feeling unwell, it’s easy to let some household chores slip through the cracks, and that includes paying bills on time.
So make paying your insurance premium a priority. You don’t want to have to use it, but if you do, you’ll be relieved that you paid on time. The lapse of a policy is the insurer’s first line of defense to keep from honoring the agreement.
Meet the Requirement of a Full-time Employee
A long-term disability policy will usually require that you be a full-time employee at the time of your illness or injury. The policy should state how many hours per week that you’d have to work to be considered a full-time worker. It’s not necessarily 40 hours. It could be as little as 30 hours.
The time interval between filing for long-term disability and receiving the first check can be substantial. It’s important that you understand what’s involved so that you and your family can devise a workable financial strategy to cope with the waiting period.
First, when you sustain the medical issue or injury that will lead to disability, your employer will most likely require you to use all of your sick leave eligibility. Once your sick leave eligibility has ended, you’ll be asked to file for short-term disability.
The length of short-term disability differs. The specifics should be spelled out in the policy, which is probably from the same insurance company that your employer uses for long-term disability. Most policies allow three to six months for short-term disability.
Finally, after you’ve exhausted your short-term disability, you’re allowed to file for long-term disability. However, there’s one important consideration.
There’s a good chance that you’ll have to leave your job before filing for long-term disability. Once again, you need to check your policy. But it’s not uncommon for insurers to insist that you no longer be on the company payroll when you file your claim.
Get a Doctor’s Evaluation
Your doctor will submit an evaluation of your condition. Obviously, it’s crucial that the opinion of your medical situation be in line with the insurer’s definition of disabled. However, even if your doctor agrees that you’re disabled, your insurer will have its medical experts review your case using your medical records. The more thorough your doctor has been documenting your case, the easier it will be for the insurer’s team to reach their conclusion.
It’s important not to miss your doctor appointments during this waiting period. If you stop going to the doctor, it sends a red flag to the insurer that perhaps your condition isn’t as serious as you say it is.
For the same reason, you should continue to make all your medical appointments even after you begin receiving long-term disability payments. You don’t want the insurer to reevaluate your situation, and cancel future payments.
File for Social Security Disability
Insurance companies survive by paying as little money as they can. This applies to long-term disability cases, as well.
In an attempt to lower the amount of money that your insurer will have to pay you, chances are that your insurance company will demand that you also file for Social Security disability. Why? The more money that the federal government pays you, the less money the insurer has to pay you.
File for Worker’s Compensation
The insurance company can pay even less if, in addition to Social Security disability, you’re also eligible for worker’s compensation. If the event causing your disability occurred on the job, your long-term disability policy would usually stipulate that you must file for worker’s compensation. Once again, your insurance company is looking for a way to cut its costs.
Beware of Exclusions to Your Long-Term Disability Insurance
If your disability occurs due to a pre-existing condition, your policy may state that the insurer will not pay benefits for the first year that your time on long-term disability begins. Carefully review your policy to learn what your insurance company considers a pre-existing condition. For example, the term may refer to a medical condition that your doctor discovered or treated three to six months before your long-term disability period started.
Your policy may also place a time restriction on how long you can receive benefits. If the medical condition that forced you out of work is one that is difficult to verify, the insurer may be willing to pay only two years.
If proof of your injury or disease can be seen on an MRI or under a microscope, your insurer is more likely to pay long term than if the insurer is unable to corroborate your story with hard evidence. For instance, the damaged spine of a construction worker who fell from a roof is recognizable by MRI. In contrast, the crippling anxiety felt by a bank teller who experienced an armed bank robbery isn’t.
Hire an Experienced Disability Attorney
Once again, the insurers are interested only in saving themselves money. The result for those people who truly need long-term disability payments can be tragic. That’s why it pays to have a qualified disability attorney working for you.
The insurance company will have a team of lawyers at its disposal. Doesn’t it make sense for you also to have legal representation?
You don’t have to navigate your way alone through the bureaucratic maze of disability coverage. Talk to the attorneys at Abell and Capitan Law today and get started with your claim. The sooner you begin, the faster you can begin receiving the insurance benefits you need and deserve.
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