Long-Term Disability FAQs

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Long-Term Disability FAQs

Long-term disability (LTD) insurance covers illnesses, injuries, and disabilities that do not stem from one’s work Many employers offer employee benefits packages that are designed to attract and keep employees, and long-term disability insurance is a common example. Many people also have their own policies that they purchase privately from insurers. Long-term disability coverage provides enhanced financial security, but if your valid claim is denied, you shouldn’t wait to discuss the matter with an experienced long-term disability attorney

Don’t Employers Have to Provide Long-Term Disability Coverage?

No, employers are required to cover employees with workers’ compensation insurance, which applies to injuries and illnesses that are job-related, but there is no such requirement in relation to long-term disability insurance. Because this form of coverage tends to be expensive, however, most policies are employment-based. Those employers who do offer LTD coverage are bound by federal laws to honor the coverage they voluntarily supply. 

What Laws Protect Me?

If your coverage is through your employer, and your employer is not the state or federal government, or a church, the Employee Retirement Income Security Act (ERISA) governs the fair implementation of your benefits, including long-term disability. If you have a valid LTD claim that is denied by the provider, the rules and regulations overseen by ERISA guide the appeals process as well as the federal lawsuit that could follow – if your appeal is unsuccessful.  If you are employed by a government entity or a religious entity – including many church-run hospitals – or if you purchased your insurance individually, your benefits may be subject to state law.

How Is Eligibility for LTD Determined?

LTD policies vary from policy to policy, but eligibility generally applies to those who are suffering a disability that prevents them from performing their own occupation, or any occupation. Long term disability claims are approved when an insured can demonstrate that they restrictions and limitations that keep them from performing work. Depending on the language of the policy, it could be the inability to perform their own occupation, or the insured may have to demonstrate that those restrictions and limitations preclude them from working in any occupation. Examples of such claims include:

  • Significant back or other musculoskeletal pain that makes it difficult to sit,stand, or lay down for any length of time.
  • Cognitive issues caused by a traumatic brain injury, a related illness, or pain medication.
  • Suffering from a chronic health condition, including pain-based conditions
  • Experiencing a severe illness that makes it impossible to perform the duties of your occupation. 

What Are Restrictions and Limitations?

In order to qualify for LTD benefits,the claimant generally must demonstrate restrictions and limitations imposed by a medical practitioner that make them unable to perform work in the economy. The type of work depends upon their current occupation, and the policy language.  A restriction is a limit on your ability to do the activity at all. A limitation allows you to perform some version of an activity, but limits how much of it you can do or the way you can do it. Examples of restrictions and limitations on your ability to work can include:

  • Restrictions on the amount of time in an 8 hour period you can spend sitting, standing or walking;
  • Limited to lifting 10 pounds or less;
  • Needing to change positions every 15 minutes
  • Limitations on the amount of kneeling or reaching you can do in your work day; 
  • Restrictions or limitations related to stressful situations or cognitive demand.

When restrictions or limitations impede your ability to work, you may have a long term disability insurance claim.

What Does LTD Cover?

Your long term disability insurance will provide a pre-set percentage of your gross wages each month.  Depending on the policy language, that percentage could include bonuses or incentives you earned over a specific prior period. Many policies will pay LTD benefits for 24 months if you are disabled from your “own occupation,” and then after 24 months require that you demonstrate you are disabled from “any occupation.” These terms are usually defined in the policy.  If you have been covered under the insurance for less than a year, your claim may be subject to a pre-existing condition limitation. That means that, if you have been eligible for benefits for less than a year, if you make a disability claim and received any treatment or testing for that same medical issue in a period of time prior to becoming eligible for insurance, your claim will be excluding because it is based on a pre-existing issue.  That time period is often 90 days, but it is governed by the language of the policy. Also, your policy may include a 24 month limitation on benefits related to substance abuse or mental illness, which includes anxiety and depression.

An Experienced Long-Term Disability Attorney Is on Your Side

Long-term disability insurance is a valuable benefit that can make a serious difference in your life if you suffer an illness or injury that requires this level of care. If, however, your claim is denied, it’s time to take action. The skilled long-term disability attorneys at Monahan Tucker Law have the experience, legal skill, and focus to zealously advocate for a favorable claim resolution that supports your rights and best interests. Our accomplished legal team is on your side and here to help, so please don’t put off reaching out and contacting us for more information today.  

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