A long-term disability (LTD) insurance policy can be a crucial way to protect yourself financially in the event that you are unable to work due to a disability. These types of policies provide a monthly benefit — typically between 50 to 60% of your salary — while you cannot work because of a physical or mental health condition. Typically, you cannot apply for LTD benefits until after a waiting period of between 3 to 6 months after you become disabled.
Even if your LTD benefits are approved by the insurance company, they may be terminated by the insurance company for several different reasons. Understanding the basis for potential termination of LTD benefits is critical to protecting your right to receive benefits.
Importantly, each long-term disability insurance policy is unique, with its own limitations, exclusions, and definitions. If you have questions about coverage under your LTD policy, consult with a New Jersey disability benefits attorney.
24 Month Limitation on Mental Health Conditions and Certain Disabilities
Many LTD insurance policies have a 24-month limitation for claims that involve disabilities based on mental health issues, as well as disabilities that are diagnosed based on subjective complaints. Insurance companies argue that these limitations are necessary because it is easy to fake or exaggerate these types of conditions. Unfortunately, those who suffer from mental illness or from a physical disability that is difficult to diagnose with objective tests are too often treated unfairly when compared with individuals with more quantifiable conditions.
If you are receiving LTD benefits due to a mental health condition such as depression, obsessive-compulsive disorder, post-traumatic stress disorder, generalized anxiety disorder, or another illness, you may be limited to just 24 months of benefits. Depending on the terms of your policy, however, if you are in an inpatient facility at the expiration of your benefits, you may continue to receive benefits until you are released.
There are often exceptions to these limitations on benefits for mental health conditions, such as for dementia and potentially for organic brain disease. A skilled New Jersey disability benefits attorney can examine your LTD policy to determine whether there may be an exemption for your particular condition.
A lawyer may also be able to argue that this type of limitation does not apply in your case because a mental health condition is linked to a physical disability. For example, in a 2012 Pennsylvania case, White v. Prudential Ins. Co. the court found that coverage for an employee’s mental illness could not be limited under his employer’s LTD policy, as it was caused by a traumatic brain injury suffered in a car accident. The employee had applied for benefits for depression and anxiety as a result of head trauma from the accident and was denied by the insurance company.
Some insurance companies may also limit coverage for disabilities that are based on subjective complaints, such as chronic fatigue syndrome, fibromyalgia, and soft tissue disorders. These conditions are often difficult to objectively diagnose, as there is not a test such as an X-ray or an MRI that will confirm the diagnosis. For this reason, these types of claims should be carefully documented from the initial application to decrease the likelihood of benefits being terminated at 24 months.
Change in Definition of Disability After 24 Months
Many long-term disability insurance policies define disability based on whether you are able to perform your “own occupation” or “any occupation.” This distinction is important, as the “own occupation” standard is much more likely to entitle you to benefits than a policy that requires you to be unable to perform “any occupation.” For example, if you are a hand surgeon and are experiencing tremors that make it impossible to perform surgery, then you absolutely cannot perform your own occupation — but you could perform many other occupations.
Most policies that specify that you are disabled if you cannot perform the duties of your “own occupation” have a provision that limits this definition of disability to 24 months. After this period of time, the standard changes to “any occupation.” In other words, you will only receive LTD benefits if you cannot perform any occupation after the initial time period ends.
This type of provision often serves to end LTD benefits for many individuals, particularly those who work in specialized, high-income jobs. However, “any occupation” will usually mean being able to earn a relatively high percentage of your pre-disability earnings (often 60 to 80%) and for which you are reasonably suited based on your skills and employment history. For people who have a good salary, these definitions often limit the job pool to jobs that are similar to their own.
How a New Jersey Disability Benefits Attorney Can Help
Long-term disability insurance policies can be complex, with limitations and exclusions that are seemingly designed to ensure that you don’t get paid what you deserve. Having a comprehensive strategy for your LTD application is critical to avoiding or minimizing unpleasant surprises down the road. A New Jersey disability benefits attorney can work with you to help explain your policy and build a strong case.
With offices in New Jersey and Pennsylvania, Bross & Frankel is dedicated to helping our clients get benefits when they need them most. We offer free disability claim reviews to all prospective clients. Contact us today at 856-795-8800, or online to learn more.