Quick Answer Whether online or reading through your paper disability coverage booklet, you will need to gather specific information about the types of coverage available to you.
Long-term disability payments may help you to meet your financial needs if you are unable to work for some time due to a covered injury or illness. Suppose you suddenly find yourself unable to work because of a serious and expected long-term injury or illness. In that case, you will need to follow your policy’s step-by-step process for applying for disability benefits.
If you find yourself in need of long-term disability benefits and need help applying for or being approved for them, our team at Pond Lehocky Giordano can help you. We work with those who are struggling to get fair compensation for disability benefits.
The Process for Applying for Long-Term Disability Benefits
If you have a long-term health or accident disability benefits plan, it may provide you with between 40-60% of your weekly wages while you are unable to work due to a covered reason. Each plan is vastly different. Each plan also has its own set of rules to follow to apply and demonstrate eligibility.
In most situations, the process follows these steps:
Notify Your Employer
You must contact your employer to let them know that you are planning to apply for long-term disability benefits. For example, if you were told you have a sudden illness, let your employer know that you have a medical diagnosis that makes it impossible for you to work. Then, let your employer know that you are planning to file for long-term disability benefits.
Review the Requirements Set in Your Policy
Whether online or reading through your paper disability coverage booklet, you will need to gather specific information about the types of coverage available to you. Your policy is likely to require medical proof of your injury or illness. This may include:
- Imaging that demonstrates the injury
- Lab reports
- Physician statements
Comprehensive medical records will need to indicate the nature of your injuries or illnesses, with a formal diagnosis. You may need a medical appointment with a specialist to clarify the severity or complications of your injuries, which includes an indication of what limitations your injuries or illness have on your ability to work. Employers will need medical records that clearly outline the nature of your disability, with clarity on the severity of the type of work you do.
Long-term disability decisions are typically made based on what the national workforce does. That is, if you do more at your job than what is typical for your job description for most people in the U.S., that could play a role in your ability to receive benefits.
Check Your Policy for Exclusions
Many long-term disability insurance policies have exclusions, or specific restrictions on when the policy’s benefits pay out. Some exclusions may include work-related accidents or claims for pre-existing injuries.
Some long-term disability policies have a waiting period. This excludes claims for injuries or illnesses that occur within the first few months of purchasing your policy.
All of the exclusions related to your policy should be documented on it. If you find that you are being denied benefits that you believe are unfair, a long-term disability attorney from our firm can offer guidance. We will investigate to determine the cause of your delays.
Apply Formally for Coverage
Once you are confident in your ability to obtain benefits, you will need to complete the necessary form from the insurance company. This will include the following steps in most situations:
- Contact the insurance company directly to inform them that you need to file a claim. Your employer’s human resources department may be able to help you in some situations.
- Complete the application completely. Do not miss any detail asked for, especially details of when the incident happened, and be sure to make it clear that your injuries or illness are one of the specific covered services.
- Include all of the required documents. These typically include medical records, your identifications, medical labs or imaging, and doctors’ reports.
You may need to follow up on the claim and answer any questions that the insurance company requests. This can become concerning in some situations where you feel your privacy is at risk. This is another indication of when you should seek legal guidance if the insurance company is being aggressive, invasive, or otherwise unfair.
Respond to requests promptly. If you are not given the information you need to complete the request, or you find that the insurance company is being unfair, do not simply accept it. Denials are not uncommon, even for just losses, and violations of fair insurance laws can be a concern in every situation.
Seek the Help of a Disability Attorney
In situations where you are hurt or ill, you believe you have the right to fair treatment from your long-term disability policy. In situations where that does not happen for any reason, or you are facing long delays and costly limitations, you can contact a disability attorney at our office to discuss what you are facing.
At Pond Lehocky Giordano, we offer comprehensive legal guidance to those who are facing limitations on their long-term disability coverage. Contact us for a free consultation to learn more about what your rights are. We provide comprehensive legal guidance to those who are not being treated fairly by their insurance provider.
