Disability insurance benefits protect your income if you cannot work and cover illnesses and conditions not resulting from work-related injuries. This insurance will compensate you for 40 to 70 percent of the income you earned before you became disabled (up to a limit).
In theory, disability benefits are a way to give you peace of mind. You are supposed to be covered when needed – at least, insurance companies tell you that in their plan literature.
In reality, insurance companies make it difficult for you to get the benefits you sorely need, and you may need to go through a legal battle. First, you must apply for benefits and make your application as persuasive and comprehensive as possible. A disability lawyer in Louisiana can help you navigate the claim process.
Types of Disability Benefits
There are two types of disability benefits:
- Initially, you will file for short-term disability benefits. Depending on the terms of your policy, short-term disability benefits will last up to six months.
- Once your short-term disability benefits lapse, you will apply for long-term disability benefits. You will be approved for these benefits if you cannot meet the work demands of your occupation. After two years, you can continue receiving benefits if you cannot perform the duties of any profession.
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How You Get Disability Insurance Coverage
You may have disability benefits in one of two contexts:
- Many employers provide disability benefits as an employee benefit. Some offer only short-term disability benefits, while others provide short- and long-term disability coverage. All employee benefits fall under a federal law called ERISA, which governs how insurance companies respond to claims and how you might appeal if they deny your claim. ERISA is an employer-friendly law, but taking on the insurance company and winning is still possible.
- If your employer does not provide disability insurance coverage, or if you want additional coverage, you will buy a policy on your own. This disability policy is a contract between you and insurance companies, and if they deny your coverage, you will file a lawsuit against them in state court.
You Must Complete a Thorough and Comprehensive Claim
You need to put time and effort into your claim application. Insurance companies are known for denying claims without hesitation, and this can quickly happen to you.
Take the time to get it right because you can make a mistake or leave out important information if you rush anything. It may be best to hire an attorney before applying for benefits. If the insurance company denies your claim and you must appeal, you will need a lawyer.
Here are some things you should do when applying for disability benefits in Louisiana.
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Review the Plan’s Definition of Disability
Each plan may have specific language and terms, and perhaps the most crucial section in any disability insurance policy is the plan’s definition of “disability.” You can only receive benefits if you qualify under the description.
In most disability policies, there is a similar definition of disability. When initially applying for benefits, you cannot perform the job duties you did before your disability. In other words, your policy is considered “own occupation” coverage, which provides benefits when you cannot engage in your work.
Although these clauses are essentially the same, you should still review the exact language of the policy. The disability insurance plan is a contract between you and the insurance company, and every word matters when determining whether you are disabled.
What may seem like legalese to you is the exact language that a court may need to parse if your case ends up in front of a judge.
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Compile Your Medical Evidence
You need your claim to be as persuasive as possible because this is your chance to put your best foot forward to the insurance company. If anything about your application needs to be added or clarified, the insurance company will not hesitate to deny your claim.
Your disability benefits claim begins with the medical evidence. You will likely have undergone treatment for your condition for a considerable period and probably have extensive medical records. Your treating doctor will also give a statement assessing your situation.
Insurance companies often insist on seeing “objective” tests, such as an MRI, because they will never take your word for it when faced with the prospect of paying a claim.
If your claim involves subjectivity, you can anticipate that the insurance company may deny it. Thus, if your condition depends on your descriptions of your daily experience, such as severe back pain or a mental health condition, you will need to include as much evidence as possible, including treatment notes from providers.
Compile Other Evidence in Support of Your Claim
Although insurance companies will likely stick mainly to the test results and the medical records, having other evidence supporting your claim is also helpful. You can view your initial claim as beginning to build the file you need if you have to appeal a denial.
You will include a personal statement with your claim, describing what you are going through because of your condition. This statement may take on more importance when your situation is subjective.
You should also consider including statements from family and friends who observe you daily. They will describe what they see and how they perceive you to be struggling in the face of your condition.
Including a statement from a vocational expert familiar with your job and possible limitations may also be helpful. They will study your medical records and say that your condition prevents you from performing your job duties.
Pay Close Attention to the Claim Requirements
Insurance companies have requirements for your claim that they lay out in the policy and may have specific formats in which they require documents to be submitted. They can also have deadlines that you need to follow. These requirements may seem technical, but you must closely follow them.
Understanding everything the insurance company wants before you submit your claim is crucial. At best, the failure to follow their requirements to the letter can result in a delay in your claim. At worst, the insurance company can deny your claim entirely, forcing you to go through the appeals process and introducing a risk that you may not get your benefits.
Wait Out the Elimination Period
Each plan will have an elimination period you must wait out before filing for benefits. You cannot file to receive benefits immediately after you have become disabled, and the duration of the elimination period depends on your policy. Each insurance company may have different terms.
Be Careful What You Do and Say
When you submit your claim application, you permit insurance companies to conduct surveillance, and they even have the right to hire a private investigator to follow you around.
The only thing that they cannot do is look into your home. The second you venture out, you become fair game for them to observe you and take pictures. If the investigator sees that you are doing anything inconsistent with what is in your application, it can jeopardize your claim.
In addition, insurance companies may be reviewing your social media accounts. You should always assume they are watching what you do or say, even if you think your account has privacy settings.
When applying for or receiving disability benefits, it is better not to say it publicly because insurance companies may even take what you say out of context and use it against you in any legal proceeding. They have the right to present any evidence that they have gathered.
Contact a Disability Benefits Attorney
You may consider hiring a disability insurance attorney to help prepare your claim for the insurance company.
You have to assume that insurance companies will deny your claim if there is even the slightest doubt or if you have missed any policy requirement. Then, you will need to embark on an appeals process that can take a considerable amount of time.
An attorney deals with disability insurance companies regularly and knows what they are looking for and how to assemble your claim to avoid some of those pitfalls. Of course, no guarantee hiring a lawyer will lead to benefits, but it can put you in a stronger legal position.
Your attorney will handle the details of your claim, compiling the necessary evidence and working with experts to give you the strongest possible file. They can also communicate with the insurance company on your behalf throughout the process. Having legal help sends insurance companies a sign that you intend to fight them throughout the entire process.
Be Ready in Case You Need to Appeal
Insurance companies are notoriously tricky regarding disability claims and are known to reject quite a few. The law governing employer-provided disability policies gives them a favorable legal landscape. Still, you can take on insurance companies and win when they wrongfully deny your claim.
The disability appeals process is one that you need to prepare for as soon as the insurance company denies your claim. You only have 180 days to file an appeal, and in that time, you will need to strengthen your appeal file to address the reasons the insurance company gave for denying your claim. The federal court will review the appeal file and decide if the insurance company made an error.
You Need a Lawyer Because the Insurance Company Is Ready to Fight
Your claim can be worth hundreds of thousands of dollars or more. If the insurance company has to pay you for the rest of your career, the claim can exceed $1 million. Therefore, insurance companies may do what is in their power to keep that from happening.
Insurance companies have lawyers working to defend them, and in some situations, they are ready to fight you until the end. In other cases, they may be more willing to settle your case because they fear legal risks.
The more insurance companies lose in court, the worse the legal precedent looks for them. When you come to the table with an experienced disability attorney who has a track record of results, insurance companies will take notice.
It does not cost you any money upfront to hire an attorney. Disability insurance attorneys work for you on a contingency basis because your money is already limited when you cannot work.
You will only pay your attorney if you have a successful outcome to your claim, meaning that you receive benefits or a settlement. If you do not receive anything, you will not be obligated to pay for your attorney’s services.
This arrangement ensures that individuals seeking disability representation can access legal experience without the burden of upfront costs.
Always Seek Guidance from a Disability Attorney for Your Claim
Navigating a disability claim can be overwhelming, and seeking guidance from a disability attorney is essential to ensure a smooth and successful process. Disability claims often involve intricate legal procedures, medical documentation, and interactions with government agencies, making professional assistance invaluable.
A disability attorney regularly deals with the intricacies of disability law and understands the specific requirements and criteria for benefits. These attorneys bring extensive knowledge and experience to the table, ensuring that your claim is presented in the most compelling manner possible.
One of the key benefits of consulting a disability attorney is their ability to guide you through the application process. They can gather essential medical evidence, complete required forms accurately, and present your case effectively to the insurance company,
In the event of a denial, a disability attorney becomes even more crucial. They can navigate the appeals process, addressing the reasons for denial, gathering additional evidence, and representing you in hearings before administrative law judges.
The guidance of a disability attorney is invaluable for individuals navigating the complex landscape of disability claims. From the initial application to the appeals process, these professionals play a pivotal role in maximizing the likelihood of a successful outcome, providing peace of mind during a challenging period.
Never hesitate to consult an attorney if you are preparing a claim. Further, if you received a claim denial, calling for legal representation should be your top priority.
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