When you sustain a disability that prevents you from working for three to six months or longer, long-term disability insurance can be a lifesaver. It provides you with a percentage of your income when you are unable to earn a living due to long-term illness or injury. Below, we provide a basic rundown of how long-term disability works, when you can use it, and how other disability awards might affect your benefits.
For help filing a long-term disability (LTD) claim and to explore all of the disability benefits you might be entitled to, call Gallon, Takacs, Boissoneault & Schaffer Co., L.P.A. and request a free consultation with our disability attorney: 419-843-6663.
When can I use LTD benefits?
If you have coverage through employer-sponsored or privately purchased LTD insurance, the first thing you will need to do after you sustain a serious disability is to review your policy. The summary plan description will include a distinct definition of “disability,” and information about how long you must wait before you can file a claim. LTD policies vary from provider to provider, and you will need to understand exactly what your policy entails and what the limitations are.
For most policies, your benefits become available when your short-term disability (STD) runs out, which is typically three to six months. LTD is essentially STD’s predecessor. Its requirements and guidelines are similar to STD, only it kicks in once your STD ends/once your elimination period is over. As with all types of disability claims, you will need to prove that you meet the insurer’s definition of disabled to obtain your benefits.
Some LTD policies pay only for total disabilities, while others pay for both total and partial disabilities. Many stipulate that you cannot file for LTD if you are still on your employer’s payroll.
If you are unsure of what your LTD policy entails or exactly what the requirements are, speak to your HR manager or insurance agent, or call our office at 419-843-6663. We would be happy to review your policy and explain the fine print.
How do I prove I am disabled?
Your treating doctor’s medical opinion of your condition and your medical records are your key pieces of evidence for proving to the insurer that you are disabled. Your records should include not only your doctor’s subjective findings and observations, but also objective tests that demonstrate your condition, such as x-rays, blood work, and surgical reports.
Some conditions are easier to prove than others. Cancer and heart failure may be much easier to prove with medical tests than soft tissue musculoskeletal injuries or an anxiety disorder, for instance. To ensure you have adequate supportive evidence for your LTD claim, have one of our attorneys at Gallon, Takacs, Boissoneault & Schaffer Co., L.P.A assess your file prior to submitting your claim.
How much will my LTD monthly benefit be?
Most LTD policies will pay claimants 50 to 70 percent of their pre-disability wages each month for total disabilities, up to a certain cap, e.g., $8,000/month.
For partial disability claimants, the insurer will calculate the monthly benefit at a certain percentage of the difference between their pre-disability and current wages. For instance, if you made $4,000/month prior to your disability and now only make $1,000/month due to your condition, your insurer will calculate your monthly benefit at a percentage (50 to 70 percent) of the $3,000 difference.
Benefits can continue as long as you are eligible to receive them, as per your plan rules. Some plans only provide LTD benefits for a certain length of time, e.g. five or ten years, while others may pay LTD until you reach retirement age.
Note, you may also qualify for Social Security disability (SSD) benefits if your condition has lasted or is expected to last a year or longer. In fact, your LTD insurer will probably encourage you to apply for SSD once you become eligible. This is because SSD benefits or any other disability benefit like Veterans Disability Compensation will offset your LTD benefits. So naturally, your LTD provider will want you to receive as many other benefits as possible to reduce the amount it has to pay you.
It is important to note that your insurer might take your SSD check for the months your SSD award should have been offsetting your LTD benefits.
What types of disabilities does long-term disability not cover?
LTD policies cover most injuries and impairments, but there are exceptions. Most policies exclude self-inflicted injuries, work-related injuries, preexisting conditions, injuries sustained while committing a felony, and injuries caused by acts of war. There may be a waiting period for conditions caused by drug abuse, alcoholism, or certain mental conditions.
You also must continue to receive treatment for your condition to remain eligible. For more information, check the exclusion and limitation clauses of your policy.
Our disability lawyers can help you get the disability benefits you need.
An estimated one-fourth of today’s 20-year-olds will become disabled before they retire, reports the Social Security Administration. And a disability can impair your ability to earn a living for a substantial amount of time. In fact, the average long-term disability recipient receives benefits for an average of 35 months, according to the 2011 U.S. Group Disability Rate & Risk Management Survey. LTD helps people stay afloat in the interim.
Our disability lawyers at Gallon, Takacs, Boissoneault & Schaffer Co., L.P.A. can make sure you take advantage of all the benefits that are available to you. Our attorneys can assist with all types of LTD disability claims at any stage of the process, from initial filing to appeals.
After reviewing your case, we can also explain whether there are other avenues of compensation that you may qualify for, such as workers’ compensation, a third-party liability claim, or SSD, and help you coordinate your claims for maximum recovery.
Contact us today at 419-843-6663 for a free consultation and learn how we may be of service to you.