One of the most serious economic risks that workers face is severe, chronic, ongoing disability, also known as long-term disability (LTD). Long-term disability refers to an impairment that prevents a worker from performing his/her job for an extended period of time, typically greater than three months. A long-term disability may prevent a worker from ever returning to work at all.
According to the National Health Council, LTDs are projected to affect approximately 157 million Americans by 2020, with almost 50% of those people having multiple conditions. Receiving long-term disability benefits, which replace anywhere from 60 percent to 80 percent of your income, often makes the difference between being able to afford your living expenses and complete economic ruin. So exactly what does long term disability cover?
LONG-TERM DISABILITY INSURANCE BENEFITS
Long-term disability insurance is not the same as workers’ compensation. To be eligible to make an LTD claim, it does not matter how you are impaired — it can be from a newly diagnosed chronic illness, a condition that has progressively worsened, or an accident outside the workplace such as a motor vehicle accident. On the other hand, to make a workers’ comp claim, your accident or illness must have occurred in the workplace or as a result of the workplace environment.
There are no laws that require an employer to offer long-term disability insurance to its employees; however, about half of mid-size and large companies do provide this benefit. Because one’s ability to earn a living is often a person’s biggest financial asset, many people purchase their own disability insurance policy to protect themselves in case they get sick or suffer an injury and can no longer work.
WHAT DOES LONG TERM DISABILITY COVER?
There are different types of long-term disabilities; not every disability can be seen. Some impairments, such as psychological impairment, may not be apparent or visible to other people at all. These types of impairments are sometimes called “invisible” disabilities and are every bit as real, disabling, and disruptive of daily life as impairments that other people can easily see.
In order to qualify for LTD benefits, your disability must be a long-term medically determinable impairment, which means that your long-term disabling condition can be proven by medical evidence and documentation, such as lab tests and blood work. Your doctor(s) needs to provide extensive documentation and objective evidence of your condition — the more documentation, the better.
Some impairments that long term disability might cover are:
Physiological (physical) impairments, including:
- Back injuries
- Balance disorders
- Brain injuries
- Cerebral palsy
- Chronic pain
- Heart Disease
- Herniated discs
- Knee disorders
- Lung disease
- Morbid obesity
- Multiple sclerosis
- Muscle problems
- Neck injuries
- Parkinson’s Disease
- Pulmonary conditions (asthma, COPD, emphysema)
- Rheumatoid arthritis
- Seizure disorders
- Shoulder injuries
- Speech disorders
- Spine injuries
Psychological impairments (which are sometimes invisible) include mental
health disorders, such as:
- Anxiety disorders
- Autism spectrum disorders
- Bipolar disorder
- Dementia brought on by Alzheimer’s disease
- Major depressive disorders
- Post-traumatic stress disorder (PTSD)
- Other invisible impairments, including:
- Brain injuries
- Certain visual disorders
- Chronic fatigue
- Endocrine disorders
- Inner-ear disorders
- Learning differences
- Recurrent arrhythmias
WHAT ARE THE MOST COMMON REASONS FOR NEW LONG-TERM DISABILITY CLAIMS?
The most common impairments for which people initiate an LTD claim are musculoskeletal disorders, cancer, mental health issues, and serious injuries.
APPLYING FOR LONG-TERM DISABILITY BENEFITS
The long-term disability application process is complicated and confusing. It can be daunting, take a lot of time and effort including attendance at hearings, and require the collection of specific, detailed, and extensive medical documentation. Many customers feel defeated before they even start. There are many technical details and deadlines to be followed; if you miss any of them, it can derail your application for benefits or have your claim denied. In addition, long-term disability insurance carriers are increasingly issuing denials of legitimate long-term disability claims.
WHAT ARE SOME REASONS CLAIMS ARE DENIED?
The disability insurance company will seek to deny your claim on any number of grounds, such as:
- Condition for basis of claim is not covered
- Missed deadlines, especially missed appeal filing or appearances
- Relying on results of “independent” medical exams disputing the severity of your disability; these exams are generally performed by a doctor hired by the very insurance company that is trying to deny your claim
- Insufficient documentation, lack of objective evidence of disability and its severity
- Claim documentation filled out incorrectly
- Social media posts and pictures indicating you are not as disabled as you are claiming
WHY YOU SHOULD HIRE AN EXPERIENCED ERISA LAWYER FOR YOUR LONG-TERM DISABILITY CLAIM
ERISA (Employee Retirement Income Security Act) is a law that governs almost all employer-provided long-term disability plans. It establishes standards of conduct for plan managers and spells out important information for employees such as timelines for filing and responding to claims.
An experienced ERISA lawyer can ensure that you adhere to established timelines, help you through the process of applying for disability benefits, advise you of your legal rights, help formulate a strategy, and give you the direction and information you need to successfully fight your claim denial. A skillful lawyer can also help you fight a denial of your long-term disability claim, and is especially helpful in successfully reversing a termination of your claim. Don’t let a technicality or ignorance of certain aspects of the law let your reversal stand or your claim terminated.
The statistics are frightening and sobering. According to the Social Security Administration, more than one out of four of today’s 20-year-olds can expect to be out of work for at least a year because of a disabling condition before they reach age 67 (the normal retirement age). Odds are that you may very well have to file a long-term disability claim and rely on the benefits in order to pay your bills and survive.
If you are faced with the prospect of filing a long-term disability claim, or your claim has already been denied, reach out today for a free case consultation.
Following graduation from Loyola Law School in New Orleans in 1990, Price McNamara served as a Federal Judicial Law Clerk to the Honorable John M Shaw, Chief Judge, United States District Court Western District of Louisiana.
Mr. McNamara founded J. Price McNamara ERISA Insurance Claim Attorney, and began putting his past experience to work for the injured and disabled clients he now represents against the insurance companies in personal injury and long term disability and other insurance disputes in both federal and state courts