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

Checklist to Apply for Long Term-Disability Benefits

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.
What would you do if an illness or injury left you disabled and unable to work for days, months, or ever again? Every year, thousands of people become disabled before they reach the age of retirement. Disability insurance offers benefits, usually based on a percentage of your salary, during the time you are unable to work. Many employees are aware that they receive health and retirement benefits through their employer, but fewer know if they have disability coverage, or what type of disability coverage they have. Whether you have an employer-provided group long-term disability (LTD) policy or an individual LTD policy that you purchased on your own could impact how you pursue your disability claim and your chances of being approved. Most employer-provided disability plans are governed by the Employee Retirement Income Security Act, a federal law commonly known as ERISA.

ERISA Law NotebookWhat Exactly is ERISA?

The Employee Retirement Income Security Act of 1974 (ERISA) was enacted to set minimum standards for employee group benefits including health, life, and disability benefits. ERISA protects benefit plans from mishandling and abuse, and ensures that employers are acting in the best interest of their employees. ERISA regulates how disability plans are managed by the employer including how disability claims are to be processed, deadlines for filing a claim, and an employee's rights if their disability claims are denied. ERISA also requires accountability and transparency, to guarantee that employees have access to information about their benefit plans. Any employee covered by their employer's disability benefit plan should receive a written summary of their plan detailing key features: how the disability plan works, what benefits are offered, and any out-of-pocket costs to be incurred by the employee for coverage.

When Does ERISA Apply?

An individual may choose to purchase disability insurance on their own or it can be provided by an employer. Some states require employers to provide disability benefits for their employees, including New York, New Jersey, California, Hawaii, and Rhode Island. Employers operating in these states must provide disability insurance regardless of where the employer's corporate offices are located. Employers who do not provide disability coverage in these states may be subjected to fines and penalties. Who provides the insurance may determine whether the disabled individual is covered by ERISA. The protective laws of ERISA only apply to private-sector companies that offer employer-sponsored benefits. It is irrelevant whether the private company is organized as a partnership, corporation, LLC, or a non-profit. Although ERISA provides protection to people who work for most types of employers, ERISA does not ordinarily apply to:

  • Privately purchased, individual insurance policies or benefits
  • Benefit plans offered through state, local, or federal government employers
  • Benefit plans offered through church employers
  • Benefit plans that are maintained only for purposes of complying with workers’ compensation, disability, or unemployment laws
  • Unfunded excess benefit plans
  • Plans that are maintained outside of the United States and are intended primarily to benefit non-resident aliens
If you have any questions about whether your disability insurance program may be covered by ERISA, contact your human resources department. If you have had a disability claim denied or terminated by your employer or insurance company, it may be time to speak with an experienced disability attorney to make sure you get the benefits you have earned.

Why is ERISA Important?

When an injured individual files a disability claim, their insurance company or employer may attempt to deny the employee's claim. The claim may be denied because the employer alleges that the individual is not disabled, they are not covered by the policy, or that the employee failed to follow the proper guidelines when applying for benefits. It is important to understand whether ERISA governs the disability insurance claim because ERISA provides the right to appeal a claim denial and file a lawsuit to compel coverage.

How Does ERISA Affect My Disability Claim?

When an employee is covered by an ERISA-governed plan, the federal law provides a number of protections to help the employee obtain disability benefits. If an employee's disability benefits are denied, ERISA demands the claimant receive copies of any documents, records, or information relevant to their claim for benefits, free of charge on request. Following an adverse decision, ERISA also requires that the claimant be allowed a full and fair review through an appeals process. While ERISA provides certain protections for employees, ERISA has been interpreted in a way that also significantly benefits insurance companies. Perhaps most importantly, if the denial of your claim is upheld on appeal, in most cases, you cannot add additional evidence to prove your disability. In addition, if you have to go to court, a judge may be required to review the denial under an "arbitrary and capricious" standard of review. That means, even if the judge would have found you disabled, he or she can only overturn the insurance company's decision if it is without a rational basis. Simply put, proving the insurance company's denial was wrong may not be enough. There are numerous ways in which ERISA effects disability claims, but the bottom line remains this: the primary purpose of ERISA is to safeguard employees who are counting on benefits that their employer promised them. ERISA is a broad and complex federal statute, and the protections that it affords claimants stated above are by no means exhaustive, and as noted above, ERISA may also negatively impact your rights, making it vitally important that you obtain all the evidence you could possibly need to prove your claim before the insurance company makes a "final" decision. For that reason, it is imperative to consult with an experienced ERISA attorney to explain your rights and fight for the benefits that you deserve.

Disability Benefits Attorney

The attorneys at Bross & Frankel, P.A. have many decades of experience representing individuals and families who have been denied benefits by their insurance company or plan administrator. There is a small window of time to appeal your disability denial, so do not delay. If you have been denied short-term or long-term disability benefits, contact our office for a free consultation.