If you’re unable to work due to illness or injury, you may be eligible for long-term disability benefits. But how does long-term disability work? And how can you avoid mistakes that lead to denied or delayed claims?
At Petro Accident & Injury Attorneys, we can guide you through complicated LTD claims and fight for fair compensation. To learn more, contact us today.
What Is Long-Term Disability?
While Social Security disability is a government benefit, long-term disability is insurance coverage that is either purchased by an individual or an employer. If you’re covered by an LTD insurance policy, you’ll have to file a claim with the insurer to get benefits.
Am I Disabled Under My LTD Plan?
While every LTD plan is different, these insurance policies share some common elements:
- Waiting period: Most LTD policies have a waiting or exclusion period before you can file for benefits. In some cases you may have to wait six months before you can apply for long-term disability benefits.
- Disability: You must prove that you have medical conditions that prevent you from performing gainful employment. Some plans will pay LTD benefits if you are simply unable to do your own occupation. However, most long-term disability plans require that you are unable to perform any occupation in the national economy.
- Exclusions and limitations: Your plan may specifically exclude certain conditions or limit coverage. For example, some long-term disability plans will only cover substance abuse and mental health issues for two years. Sometimes, there are exclusions to the exclusions — and it’s important to read your SPD and other plan documents carefully.
Reviewing Your Policy
There are two primary forms of LTD plans, and the rules and legal procedures surrounding them are different. For this reason, before you file a long-term disability claim, it’s a good idea to review your plan documents and identify which form of LTD policy you have.
- ERISA plans: Disability insurance plans that are employer-sponsored fall under a federal law called ERISA (Employee Retirement Income Security Act of 1974). If your employer funds your LTD policy, it is an ERISA plan. You must follow a strict claims and appeal procedure — and all lawsuits are heard by the federal courts. You cannot request a jury trial and there are strict filing deadlines in these claims.
- Non-ERISA plans: If you purchased long-term disability insurance privately or individually, you have a non-ERISA claim. These claims fall under state law, meaning you can request a jury trial if the insurance company denies your claim.
If you’re not sure whether you have an ERISA or non-ERISA disability plan, it’s a good idea to consult with an LTD lawyer. An attorney can help you review your policy’s Summary Plan Description (SPD) and identify which laws apply to your claim.
Filing a Claim
Next, you’ll need to file a claim. This involves completing a series of forms, providing medical evidence that supports your claim, and other important information. While some people file LTD applications on their own, it’s typically in your best interest to consult with an attorney early on in the process.
In an ERISA claim, you only have a limited time to submit your evidence. While you can provide as much documentation and evidence as you want or need during the application and “administrative appeal” levels of your LTD claim, this changes dramatically once you file a federal lawsuit. The federal judge can only consider evidence and information that the insurance company had — you cannot submit new evidence regardless of its importance.
When you hire a Birmingham AL LTD lawyer early on, you reduce your risk of making these kinds of mistakes. At Petro Accident & Injury Attorneys, we understand ERISA procedures and build strategies that aim to strengthen your case and claim. We pride ourselves on our intense attention to detail and sophisticated medical knowledge — and use these strengths to our clients’ advantage.
What If My LTD Claim Is Denied?
If you have an ERISA claim, you cannot immediately file a lawsuit when the insurance company denies your claim. Instead, you must “exhaust your administrative remedies,” and file an internal appeal with the insurer. Since these appeals typically have strict filing deadlines, it’s best to consult with a lawyer immediately upon receiving a denial.
At this administrative appeal level, you can submit additional information that supports your claim — and it’s vital that you do this. Depending on your circumstances, your LTD lawyer may provide additional medical records, statements from your physicians or expert witnesses, and opinions from vocational experts. Then, the insurance company will review your claim again and issue another decision.
If they approve your claim, you should start receiving benefits. If it is denied again, you can file a federal court lawsuit. As mentioned above, you will not get a jury trial in an ERISA case. Instead, a federal judge will review your claim and evidentiary record and decide whether you’re legally entitled to benefits.
Speak to a Birmingham AL Long-Term Disability Lawyer Today
How does long-term disability work? How do I file a claim? What can I do if my claim is denied? For answers to your questions, contact Petro Accident & Injury Attorneys today. Our experienced disability insurance lawyers can inform you of your rights and legal options. We have helped countless disabled individuals in Alabama get the benefits they deserve. Contact us today for a free consultation.