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Disability Insurance
Purchasing short-term and long-term disability insurance policies is a smart decision that protects employees from wage loss in the event of a medical condition that impedes their ability to work. These policies are sometimes offered by employers but can also be purchased privately.
Short-term and long-term disability insurance policies are either paid via a payroll deduction or directly by premium payments and allow the policyholder to continue receiving a portion of their salary while they are disabled.
When to Use Your Policy
The Centers for Disease Control and Prevention (CDC) defines a disability as “any condition of the body or mind that makes it more difficult for the person with the condition to do certain activities and interact with the world around them.” If this applies to you and your work, you are likely eligible to receive your LTD payout.
Long-term disability insurance is designed to help cover your expenses if you are ever in a situation where an injury or illness is keeping you from your job for a prolonged period of time. Depending on your policy and ailment, the length of time you are eligible for benefits may range from a few months up until retirement.
Common Conditions that Are Covered
These are some of the more common conditions that LTD recipients have. If your condition is not listed and you are out of work, you may still be eligible to receive LTD:
- Autoimmune diseases: Lupus, Rheumatoid Arthritis, Crohn’s disease, Scleroderma, Psoriasis.
- Accidents and injuries: Broken bones, Burns, Head/spinal trauma, Amputations.
- Cancer: Lung, Breast, Prostate, and Kidney, among others, depending on type and stage.
- Cardiovascular diseases: Coronary artery disease, Peripheral artery disease, Carotid artery disease.
- Depression: Severe depression can have lasting physical and mental effects on an individual and prohibit a normal working experience.
- Diabetes: Type 1, Type 2, Gestational Diabetes.
- Mental health disorders: Anxiety, Bipolar disorder, Schizophrenia, Substance use disorders, Personality disorders.
- Musculoskeletal disorders: Fibromyalgia, Tendinitis, Carpal tunnel, Osteoarthritis.
- Neurological disorders: Alzheimer’s disease, Meningitis, Parkinson’s disease.
- Strokes: Strokes can have lasting cognitive and muscular effects on a victim.
We Specialize in Helping Those With Policies From:
- Aetna
- AIG
- Cigna
- Guardian
- Colonial Life
- The Hartford
- Liberty Mutual
- Mass Mutual
- Met Life
- Mutual of Omaha
- New York Life
- Northwestern Mutual
- Prudential
- Sedgwick
- State Farm
- Unum
Don’t see your carrier? Don’t worry, our team of experts is well-versed on the ins and outs of over 30 other LTD carriers.
Employer or Private Insurance
Employer-provided policies may be governed by the federal Employee Retirement Income Security Act (ERISA), which has strict and complex rules for how and when to file a claim or appeal the denial of one. Privately purchased policies are not subject to ERISA; they are administered in accordance with the contractual terms of the policy.
Like Social Security disability claims, the applicant must prove they are medically unable to perform their job, but the standard for doing so is typically easier to meet for short-term and long-term disability insurance. The claimant need only prove they cannot perform their regular occupation, and age is not a factor. The Social Security Administration, by contrast, holds younger applicants to a stricter standard than older individuals.
Timing
Policies differ, but most require a six-month waiting period before long-term disability payments commence. The majority of policies provide payments until the claimant reaches the age of 65.
However, at any point until that time, the insurance company is permitted to request a review of the claim to evaluate whether the disability has changed or lessened in severity. If their medical experts determine that is the case, they will immediately deny the claim and discontinue payments — unless the claimant successfully sues to overturn that determination.
The definition of “disabled” will be established in the insurance policy, but generally policies define it as being unable to perform a regular occupation.
Denied Claims
Claims administrators may be employed by the insurance company, and many deny first-time claims even if they are justified. Reasons given for denying a claim include (but are not limited to):
- Insufficient medical evidence (such as a lack of regular medical treatment, adequate records, or a doctor’s statement).
- Failure to meet the policy’s definition of disability.
- Video surveillance by the insurance company that conflicts with the claim.
- Missed application deadlines.
Appeals
Policyholders have a right to appeal a denied claim and any determination that was made in that denial. There are strict deadlines to file appeals, however. Under ERISA and many private policies, the appeal must typically be filed within 180 days.
If the appeal is also denied, the policyholder can file a lawsuit in federal court. There is no right to a jury trial in these cases; a federal judge will review the basis for the insurance company’s decision as well as medical expert opinions and information presented by the policyholder rebutting it. The judge will decide whether there was a rational basis for denying the claim or not.