Employers often provide full-time employees with a wide array of benefits including health, life, dental, and vision insurance coverage along with disability insurance. An employee's disability policy may include both short-term and long-term disability benefits.
Depending on the terms of your particular policy, short-term disability benefits are usually only available for 1-6 months. Once the short-term disability benefits expire, it is imperative to immediately apply for long-term disability benefits. Depending on the policy, long-term disability insurance pays a percentage of your salary, typically 50 to 60 percent. The benefits last until you go back to work or for the maximum number of the years stated in the policy.
Don't make the mistake of assuming your short-term disability benefits will automatically roll into long-term disability benefits. Quite the contrary. In most instances a separate application for long-term disability benefits (LTD) is mandatory.
Applying for LTD Benefits in 7 Simple Steps
1. Examine and Understand your LTD Policy
If you become disabled and are unable to work for a period of time or indefinitely, it is important to carefully review your disability insurance policy options. If you have a private LTD policy, your policy documents will explain the process for applying for benefits.
Your policy defines the disabilities that are covered by your policy. This definition will outline what you have to prove to be eligible for benefits under your policy. Certain conditions, such as those related to pre-existing conditions, or drug or alcohol abuse, are typically excluded from coverage. Likewise, your benefits may be limited if your disability is cause by mental health/psychiatric limitations or, in some cases even a more subjective impairment than on an objectively quantifiable one. Examples of such "subjectively reported" conditions can include fibromyalgia, chronic fatigue syndrome, and migraine headaches.
2. Ask Your Employer for an Application
Your employer's Human Resource department can be an invaluable resource throughout the application process. Someone in your HR department should be able to provide you with an application and important instructions to complete your LTD application. Keep in mind that if your policy was provided by your employer, it is likely governed by federal law. The Employee Retirement Income Security Act (ERISA)
regulates applications for long-term disability benefits under these policies. Under ERISA, you have the right to receive a copy of your plan description and policy documents upon written request.
If your employer fails to provide you with the necessary application and procedures to apply for LTD benefits, there is a good chance that the forms necessary to apply for LTD benefits will be available on the insurance company or claim administrator’s website. The following are examples of long term disability claim forms taken directly from insurance companies’ websites:
3. Submit the Employee Statement
You will be responsible for completing a section of the LTD application often referred to as the Employee’s Statement. The requirements of the Employee’s Statement vary depending on the insurance company, but will generally include information such as:
- Your name
- Social Security number
- Date of birth
- Address and phone number
- Name of your employer and your occupation
- Your work history and education information
- Date of your injury or illness
- Description of disability
- Last date worked
- List of medical providers and contact information
- All prescribed medications
- Other forms of income that you may be eligible to receive
You will want to complete every question completely. However, the form may limit the space available to respond, so use an additional page if necessary to give full and complete answers.
4. Obtain Your Employer's Statement
The LTD application will also require your employer to provide certain information. Such information could include your hire date, job description, salary, the physical and psychological requirements of your job, the date insurance coverage became effective, last day worked, and the date you returned to work (if applicable).
5. Collect Medical Records & a Statement From Your Doctor
It is important to see a doctor prior to applying for benefits since the insurance company will require medical proof of your disability. You may have to submit a signed authorization that allows the insurance company or administrator to request your medical records. Your signature will let the insurance company get the information about you that they need to determine your eligibility for benefits.
Additionally, as part of your LTD application, your doctor will be asked to complete a form or write a statement regarding his or her opinion of your condition. The insurer will usually request that your doctor provide information about dates of treatment, symptoms, findings, diagnoses, determination of whether your injury or illness is work related, types of treatment, objective estimate of your physical limitations and/or mental impairments, an approximation of when you may return to work, and any other information that the physician deems pertinent. If your doctor is not supportive of your claim, it may be very difficult for you to prove your disability and qualify for benefits. It is a good idea to speak with your physician prior to starting your application so you can be sure he or she supports you.
To show that your disability is ongoing, you should continue to receive treatment from your doctor while your LTD claim is pending; even after you are approved for benefits. Failure to continue treatment could be grounds for the insurance company to terminate your benefits.
6. Apply for Additional Benefits
If your LTD claim has been granted, most policies will require you to file for Social Security disability benefits
as well. Any Social Security benefits you receive will offset the amount the LTD insurance company is required to pay. Thus, your LTD insurance company has a significant interest in seeing you approved for Social Security benefits. Because of this interest, the insurer may refer you to a national company to assist you with your Social Security application. It is important to remember that these companies are focused primarily on saving the insurance company money. They may not be attorneys, and may not put your interests first. Bross & Frankel can assist you with your Social Security disability application. Call (856)795-8880 today to learn more.
7. Consider Contacting An Experienced Long-Term Disability Attorney
Since LTD claims are complicated and frequently denied, you may want to seek advice from an attorney who specializes in long-term disability claims and ERISA. If you apply for disability and are denied, you have the right under ERISA to sue the insurance company in federal court. Please be mindful that a denial of disability insurance benefits must be timely appealed. If you fail to submit a written appeal to the insurance company or administrator, you may forfeit your claim for LTD benefits.
An attorney can not only help you submit a LTD benefit application but also knows how to maximize the chances that you will be approved for benefits. If the disability application process has you at your wits end or your claim LTD benefits has been denied, contact the experienced and skillful disability attorneys at Bross & Frankel for a free consultation.