Long-term disability (LTD) insurance provides monthly payment benefits (or a portion of your income) if medical reasons or disability prevent you from performing your job. Unfortunately, filling out a disability benefits application can be daunting, time-consuming, and frustrating, especially without expert guidance. Here are several key factors to remember when planning to file an LTD claim:
Review and Understand the Terms
Whatever type of LTD policy you have,
– Individual (purchased on your own)
– Group (through your employer)
obtain the policy itself before deciding to file a claim. You can request a copy of the policy and a summary plan description from human resources. If you are an individual LTD policy holder, contact your insurance company. Make a request in writing for all the LTD plan documents. Once you receive them, review them carefully. Pay extra attention to the following key areas:
1. Definition of Disability – The definition of disability is the most important element of the LTD claim. Most plans will consider you to be disabled during the first two years if you are unable to perform the essential duties of your own occupation. After this two-year period, you will then need to meet a stricter test of disablity and will need to show you are unable to perform the duties of any occupation. The defitinion of disability and duration of the specific disabiity tests may differ between different policies. It is important to review the definitions listed in your policy.
2. Time Period – All LTD policies set a strict deadline for filing the initial application and subsequent appeals. Most insurance companies deny claims submitted after the time limit provided. Consult a qualified long-term disability insurance lawyer immediately to help assess and initiate your claim.
3. Exclusion – LTD insurance companies may not compensate disabilities resulting from pre-existing health conditions. While this exclusion is applicable in the first year of coverage in some policies, check the terms and conditions of your policy. Other exclusions from coverage may include:
– Drug and alcohol abuse
– Attempted suicide
– Disability caused by a participation in a crime
Medical Records and Doctor’s Opinion
Supporting your claim with medical evidence is a crucial element. After filing the claim, the insurance company requires you to submit recent medical records (e.g. MRIs, X-rays, lab results, and physician’s notes about your limitation or inability to work). Check the medical records for any inaccuracies and have them corrected by the doctor’s office promptly.
If the insurance company denied you long-term care benefits, you may be offered up to two administrative appeals. Hiring a highly experienced LTD insurance lawyer from the beginning will assist you with collecting medical evidence and making your case. However, if your initial claim was rejected you can still enlist legal help for the appeal.
Please call Michelle Linka Law at (416) 477-7288 for expert legal advice. Our team of professional legal experts protect your rights and help you receive the disability benefits you deserve. No matter what size of claim, we will provide exceptional service and care.