Generally, any injury that lasts at least six to twelve months and keeps you from working is considered a long-term disability in Baton Rouge. Louisiana doesn’t have a specific law defining a long-term disability, and the exact definition differs depending on the specific insurance program.
If you believe that your employer-sponsored long-term disability claim has been wrongly denied, a Baton Rouge long-term disability lawyer can help. A lawyer can challenge the denial and work to prove the extent of your long-term disability.
What Is the Definition of Long-Term Disability in Baton Rouge?
There is no one single legal definition of “long-term” disability, and different disability insurance policies have different working definitions. Generally, though, a long-term disability is a diagnosed medical condition that lasts at least six months and keeps you from engaging in gainful employment.
This is in contrast to short-term disability, which is a disability that typically lasts between three and six months. The definition of long-term disability matters because it determines whether your condition will be covered under your employer-sponsored plan.
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Common Medical Conditions that Qualify as a Long-Term Disability
Keep in mind that each policy has different qualification criteria, so make sure you understand the specific details of your plan. Below are some common conditions that can be considered a long-term disability in Baton Rouge:
- Physical injuries. Traumatic physical injuries, like brain injuries or amputations, can cause permanent impairments that impact motor and cognitive abilities.
- Chronic disease. Chronic illnesses like heart disease and rheumatoid arthritis can prevent a person from performing their normal work duties.
- Neurological disorders. Conditions like epilepsy or cerebral palsy impact the brain and can cause permanent disability or developmental issues.
- Respiratory conditions. Respiratory conditions like COPD, asthma, or cystic fibrosis can become severe enough to prevent an individual from working.
- Musculoskeletal issues. Common musculoskeletal issues that qualify as long-term disabilities include arthritis, spinal degeneration, and carpal tunnel. They can limit one’s capacity to earn a living.
- Organ damage. Organ damage from physical trauma, disease, or toxic exposure can require constant medical care that prevents holding consistent employment.
- Autoimmune disorders. Autoimmune disorders like lupus or multiple sclerosis can cause widespread issues that disrupt normal work functioning.
- Mental health conditions. You can get long-term disability for mental health disorders, such as depression, anxiety, or PTSD.
Note that long-term disability insurance is usually not used for injuries sustained at work. For work injuries, you would instead take workers’ compensation benefits to recover your lost income and medical costs.
Proving a Long-Term Disability Claim
When you file a claim for long-term disability, you will need to provide evidence for your condition and how it limits your ability to work. A comprehensive record of medical documentation and treatment efforts is the most important type of evidence to obtain. These records include:
- Doctor’s notes
- Imaging results
- Diagnostic tests
- Lab reports
- Rehabilitation records
Your documentation needs to show the severity of your injuries and how they limit functionality and make you unable to work. Generally, you must show an official diagnosis and evidence of adhering to a treatment regimen.
One of the most common reasons insurance companies deny disability claims is a lack of evidence. So it’s important that you see a doctor as early as possible and take proactive steps to document and manage your condition.
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What Should I Do If My Long-Term Disability Claim Was Denied?
If your long-term disability claim was denied, it’s important not to panic and to take proactive steps. Insurance companies have a process to appeal long-term disability denial of benefits.
Here’s how you should proceed after a denial:
- Get your full claim file. You first need a full copy of your claim file. This file should contain all your insurance information and the reason why your provider rejected your claim.
- Gather additional evidence. When filing an appeal, you’ll need to present additional medical evidence to validate your claims. Make sure you understand the reasons why you were denied so you can get the right supplement documents.
- Get work history from your employer. If necessary, you can also get additional statements from your employer attesting that you are unable to perform your normal job duties.
- Hire a lawyer. You should also look for an experienced disability insurance lawyer. An attorney can organize your documents and represent you during negotiations.
Rules for appealing employer-sponsored disability insurance decisions are governed by the Employment Retirement Income Security Act (ERISA). If you appeal the decision and your insurance provider still continues to deny benefits, your lawyer can file a formal lawsuit to coerce them into honoring their payment obligations.
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Reach Out to an ERISA Insurance Claim Lawyer in Baton Rouge
The federal government has laws that regulate insurance coverage for employer-sponsored disability insurance plans. If you believe that your disability insurance claim was denied in error or that the insurance company is illegitimately denying your claim, you can talk to a disability insurance lawyer in Baton Rouge.
Do you have further questions about what is considered a long-term disability in Baton Rouge? Contact ERISA Insurance Claim Attorneys online or call today to speak to a lawyer about your legal options.
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