Thank you for visiting our website and for giving us the opportunity to see if we can help with your situation.
We understand that a denial or cessation of benefits can put you under considerable financial and emotional strain. Our experienced and friendly legal team understands what it takes to obtain your benefits.
The details of obtaining Long Term Disability Benefits can be confusing. This only adds to your frustration and stress. We are experienced in handling the different aspects of this area of law. In this portion of our website, we would like to explain some of the basics of Long Term Disability to you.
We appreciate the time you have taken to review this information. If you would like an evaluation of your claim, please contact our office at:
- What is Short Term Disability?
Short Term Disability is coverage given to an employee to provide a replacement for lost income because of a health issue. This coverage is just what it sounds like - short term. Employees are given Short Term Disability Benefits when they are, because of a physical or mental illness, unable to perform their job. These benefits are limited to a certain amount of time, often three to six months.
- What is Long Term Disability?
Long Term Disability is coverage given to an employee to provide a replacement for lost income because of a health issue that is expected to last an extended period of time. Employees are given Long Term Disability Benefits ("LTD") when they are, because of a physical or mental illness, unable to perform their job. LTD Benefits are provided after the term for Short Term Disability Benefits has expired. The amount of LTD is usually based on a percentage of the worker's wages or salary. LTD is not provided by the government, but by private insurance companies. It is usually provided as part of a group insurance coverage plan that is a benefit of employment.
- Why was I denied Long Term Disability?
Usually workers are denied Long Term Disability because the administrator of the benefit program has decided the worker's disability has been temporary, and an extended period of coverage is not applicable. This means the examiner who makes the decision feels the worker is now able to return to work. The examiner has consulted a medical source, either through the company or the worker's own medical provider, and obtained an opinion that the worker is able to return to work before the period of Long Term Disability Benefits would begin. Also, the examiner may have consulted a Vocational Expert to look at the different types of jobs you could do.
- Why was my Long Term Disability Ceased?
If you receive Long Term Disability Benefits, your case will be periodically reviewed to determine if you are still disabled. Just as in the initial decision to grant your benefits, an examiner will consult their own medical source or your medical providers, and also will consult a Vocational Expert. If the examiner feels your condition has improved to the point that you are able to return to work, your benefits will be ceased.
- What do "Own Occupation" and "Any Occupation" mean?
"Own Occupation" is the job an employee is doing at the time they become disabled. You should be aware of the definition being used in this decision to ensure the correct occupational descriptions are being used to evaluate your claim.
After a period of time specified in the insurance policy, the company is allowed to look at "any occupation" to determine if you are still disabled. This does not mean any job in the world, but is limited to jobs that match your abilities and limitations as specified by a medical source. The examiner can only consider jobs that you could reasonably be able to do given your education, training, and experience. Once again, a Vocational Expert is usually consulted to determine if you are able to do "any" job based on all of these factors.
- How do I appeal a denial or cessation?
When you receive a denial of LTD or if you are receiving LTD benefits and then they are stopped by the insurance company, you have a right to appeal that denial. The first appeal is completed "in house". This means you file your appeal with the person administering your employer's insurance plan. This person or their staff will gather information in your case. You may also submit information to be used as evidence to show your disability. The information you submit should specifically address the reasons you were denied. You have a limited amount of time to appeal a denial, and a limited amount of time to submit evidence. These deadlines will be stated in your policy. The examiner will then make a decision based on all evidence supplied.
It is important to hire an experienced and knowledgeable attorney before appealing. This is the last step in which you can submit additional evidence.
- What is ERISA?
ERISA stands for Employee Retirement Income Security Act of 1974. This legislation defines the rules and procedures for handling a Long Term Disability claim.
- What happens in Federal Court?
If your LTD has been denied or stopped, you have already appealed that denial to your insurance provider, and have still been denied benefits, you have the right to file a lawsuit in Federal Court. Once again, there are deadlines in this process. You have a limited number of days after the date of your denial to file a suit in Federal Court. This lawsuit is filed using the rules and procedures defined by ERISA. The procedures used in this type of suit are a little different. There is most often not a trial. The case is decided by the judge. Also, the case is decided based on the information already in your file. No new information is allowed. The insurance provider is required to provide your entire record to the court. The court will require you and the insurance company to submit "briefs" to the court. A brief is simply your written argument - it tells your side of the issue. If your case is not settled, once the briefs are submitted, the judge will make a decision about the case.
Hopefully, you will have hired an attorney while your case was being decided by the insurance company. If you have not, you will definitely need an attorney to proceed in Federal Court.
- Is it possible that my case will settle?
Sometimes these cases settle and sometimes they don't. Your case will settle only if both you and the insurance company agree on how much you should be paid. Insurance companies typically want to "buy out" your claim by paying one lump sum, which releases them from any future obligation.
- What damages am I entitled to?
If your claim is approved in Federal Court, you will be entitled to past due benefits (back pay), interest, your filing fee, and continuing benefits. You may also be entitled to some of your attorney's fees.
- What is an offset? - Long Term Disability and Social Security Disability
Many people who receive Long Term Disability also receive Social Security Disability. It benefits the insurance provider if you are also on Social Security Disability. This is because the amount you receive as Social Security Disability is used to "offset" the cost to the LTD provider. This means that your benefit from your LTD provider is reduced by one dollar for every dollar you receive from Social Security. As an example, if your LTD provider would pay you $1,000 each month and you start receiving Social Security Disability which pays you $800 each month, the LTD provider will reduce their monthly payments to $1,000 - $800, or $200 per month. Also, if you receive a check from Social Security Disability for backpay, any or all of that amount can be used to reimburse the LTD provider for payments they have already made to you. Because of this direct benefit to the LTD provider, many LTD providers require you to apply for Social Security Disability Benefits if you receive LTD Benefits.
- How are my attorney fees paid?
If we take your LTD claim, we do so on a contingent basis for attorney fees. This means we get paid only if we are successful with your claim. Success can mean receiving a decision by the LTD provider or the Federal Court judge in your favor. It can also mean obtaining a settlement for you.
- What will expenses be?
We require reimbursement for expenses. Expenses are completely separate from the attorney fee, and in addition to the attorney fee. Any amount we receive for attorney fees is for the education, knowledge, experience, and time put into your case. Expenses are payment for medical records we request or medical reports we may need in preparing your case, court costs, and mileage to any hearings a judge may require.
