Across the United States, 61 million adults live with a disability. While most of us think that it could never happen to us, the reality is that at some point in our lives, there is a substantial likelihood that we will be diagnosed with some type of disability. If that physical or mental health condition leaves you unable to work, a long term disability (LTD) insurance policy can provide a measure of financial security.
LTD policies provide a percentage of your monthly salary if you cannot work because of a disability that lasts for an extended period of time. Unfortunately, even if you faithfully pay your premiums for years, your insurance company may still wrongfully deny your LTD claim, delay paying your benefits, or end your benefits early. In these situations, a Philly long term disability attorney can advocate for you and help you get the benefits that you deserve.
Bross & Frankel is a Philadelphia law firm that is devoted to fighting for the rights of people with disabilities. With more than 90 years of combined experience, we understand how the system works — and put our knowledge to work for our clients. From an initial claim review to the final resolution of your claim, we will stand by your side and help you get the best possible result.
Understanding Long Term Disability Insurance
Long term disability insurance is a specialized type of policy that is often available through employers’ group plans. You can also buy it as an individual. Because it offers monthly payments of up to 50 to 60% of your salary if you cannot work, it is an important part of an overall financial plan.
If you become disabled and cannot work as a result, your LTD policy will provide benefits for anywhere from 24 months, until you can return to work, or up to retirement age. There is a waiting period (typically 6 months after you become disabled) to apply for these benefits.
For policies that were purchased through a group plan, the federal Employee Retirement Income Security Act of 1974 (ERISA) will govern the administration of the policy. Under ERISA, your insurance company must provide certain information to you and offer an appeals process. If you purchased your policy individually, then it will be governed by state law.
If your insurance company acts in bad faith or otherwise violates the law or the terms of your policy, you can file a lawsuit against it in either federal (for ERISA claims) or state court. Before doing that, you will need to exhaust the administrative appeals process with your insurer. A Philly long term disability attorney can evaluate your LTD policy and counsel you on your rights under it.
Wrongful Denials of LTD Claims
Like all insurance companies, insurers who offer LTD policies are in the business of making money. In fact, some of the biggest insurance companies — like The Hartford — rake in billions of dollars in profit each year. These corporations don’t post these kinds of profits because they pay out on LTD claims, but because they look for ways to deny or minimize their liability for LTD claims.
Insurance companies use a number of tactics to achieve this goal, from terminating benefits early to delaying claims to denying claims outright. For example, an insurance company may ask to submit and resubmit documentation of your disability, pushing out a decision on your application for benefits for months or longer. They often employ their own teams of medical professionals, who will review your application and decide — without ever examining you — that you are not truly disabled or unable to work.
Other strategies for denying claims may include using surveillance to gather information about you in order to deny your claim, requiring you to undergo an independent medical evaluation to argue that you are able to work, or denying your claim on the basis that you have a pre-existing condition. An insurer may also exercise a clause in your policy to terminate benefits after 24 months or end your benefits because you no longer meet the definition of disabled under the policy.
One of the best ways to prevent this from happening is to consult with an experienced LTD lawyer as soon as possible. Many LTD denials are based on the terms and conditions of the insurance policy. An attorney can evaluate your policy and advise you on the best way to avoid a denial or an early termination of benefits.
If your claim is denied, you typically have a limited period of time to file an appeal with the insurance company. From there, you may be able to file a lawsuit in state or federal court for a bad faith or wrongful denial of your claim. A Philly long term disability attorney can help you file an initial appeal, and then pursue a lawsuit if that appeal is unsuccessful.
Considering an LTD Claim? We Can Help.
No one wants to be diagnosed with a disability or to be forced to stop working because of that disability. Yet for millions of Americans, this is reality. If you find yourself in this position, we can help, starting with a free claim review and continuing throughout the LTD claims process.
Bross & Frankel focuses our practice on disability benefits. We represent people throughout the Philadelphia area who are unable to work due to a physical or mental health condition, helping them get the benefits that they are entitled to under the law. To learn more or to schedule a free claim evaluation, call us at (215) 545-5990 or email us at any time.