How to Get Long-Term Disability Insurance Approved

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Do You Know These Disability Stats?

(from Council of Disability Awareness)

  • The most common long-term disability claims are due to:
    • Musculoskeletal disorders
    • Cancer
    • Pregnancy
    • Mental Health
    • Injuries.
  • Fewer employers today are offering benefits to workers.
  • Almost half of American adults cannot pay a sudden bill of $400 without taking out a loan or selling something.
  • The largest group that files bankruptcy is struggling due to medical bills.
  • The average monthly SSDI benefit as of January 2018 was only $1,197, not even $15,000 per year.
  • 1 in 5 people in America has a disability (United States Census Bureau)

With statistics like these, it is apparent that long-term disability insurance can benefit people if it is available to them.

What is Long-Term Disability Insurance (LTDI)?

Typically, long-term disability insurance is helpful for those that need benefits for at least two years or who are also waiting on SSDI approval or benefits to kick in. It usually replaces 50% to 80% of a person’s income. Depending on your policy, support from this type of insurance can last until you reach retirement age (usually age 65) according to Social Security, or until death. Also, if you can no longer prove that you are disabled, you will no longer be entitled to benefits. It basically comes down to the insurance benefit period and the policy that you signed up for. LTDI covers disabilities of many kinds, from degenerative disease to conditions resulting from a tragic accident.

Some employers provide long-term disability insurance coverage, but because it is not legally required, many do not. If it is not available through your job, then consider shopping around for affordable plans that offer adequate coverage. Also, a person can get a supplemental LTD policy if coverage from their employer is not sufficient. Note that this is different from basic LTDI.

The federal law that governs LTDI policies is ERISA (the Employee Retirement Income Security Act). The ERISA claims administrators are the individuals that evaluate all applications, but these same administrators simultaneously work for the insurance company and readily deny claims. It is important to be diligent, timely, and thorough so that all necessary bases are covered for approval.

There are many things to think about such as:

  • Whether or not the insurance policy you choose will increase benefits to coincide with inflation and cost of living.
  • Will they be able to change your premiums, benefits, etc. without consulting you (consider renewability clause)
  • Can you lengthen the waiting period (aka elimination period) in order to reduce your premiums (and the cost increases with age, so get it now rather than later)
  • What riders (additions) do you need? Some are free!
  • How financially stable is the company providing the LTDI?

Get Clear On What Long-Term Disability Is NOT

Long Term Disability is not the same as workers’ compensation, which only covers you if you are hurt in an accident on the job. It’s also quite different from Social Security Disability Insurance (SSDI), which is a government funded program that takes longer to get, has stricter criteria, and pays only an average of $1200 per month.

It is worth noting, however, that it can be possible to receive SSDI even after you have been receiving for LTDI, it just depends on your circumstances. When this happens, the insurance will tend to shift into paying the difference between the amount of your LTDI policy and the lesser benefit amount that you begin receiving from the SSDI.

Vital Steps to Qualify for Disability Insurance Coverage

Make Sure You Meet Their Definition of “Disability”

Sometimes a single disability is enough, and other times, a person is considered disabled due to a combination of ailments. Furthermore, do the disabilities make it difficult to perform daily activities and work? Unlike an SSDI, which requires that a person be fully disabled, an LTDI is a bit more lenient. With this said, there are different requirements for different insurance companies, and some will require you to actually apply for SSDI benefits. Check your policy and review their summary plan description. You should be able to find their exact definition as well as excluded conditions there. Some conditions are accepted, but only for a short time. Excluded conditions often include anything connected to substance abuse or pre-existing conditions.  

Be certain if your LTD is (or will be) an “own occupation” or “any occupation” policy.  “Own occupation” will cover someone if they are disabled from working their specific vocation. So if you are able to work other jobs, you still receive benefits. “Any occupation” will require you to be unable to work any job, so it is more difficult to get these benefits, although the policy will be cheaper. You should also know that “own occupation” can switch to “any occupation” after around two years.

*Beware that insurance companies use investigators who will attempt to catch you on video doing things you say you are unable to do. If they manage to catch you on a good day, this can be used against you for a denial and even terminate any benefits you already had to begin with.

Be Prepared to Prove You Are Legit

Proving disability for LTDI is less tedious than it is for getting SSDI, but there are still a lot of demands to prove disability. You will absolutely have to have medical documentation. There is simply no way around this. You will almost certainly have to go to a lot of medical visits to the physician and specialists or mental health providers, and you will have to show the paper trail to prove it. Your doctors will have to provide their detailed medical opinions as well, and make sure that they include how your disability impairs your ability to work. So collect all of your medical records and make sure they are organized.

*DO NOT trust simply filling out forms from your insurance company.  They are created in such a way to support a denial.

Meet the Deadlines

Whether you are applying or appealing, deadlines are crucial. The usual time limit for an appeal is 180 days. An attorney can help you to meet these deadlines in the most efficient way. Missing the deadline will assume that you have failed to exhaust your administrative appeals, and you will be flat-out refused the ability to sue the insurance company in federal court. If you get a denial, make every effort to note the filing deadline and move fast to meet it. There is really no time to waste when you want to appeal.

Process Easier, Faster, and With the Best Possible Benefits

The way that you can help ensure that you get the best results from the long arduous process of applying from medical benefits such as LTDI or SSDI is by consulting a disability attorney. They can help you through the claims process by helping you to understand your options for disability benefits and assisting with adequate documentation.

Some people choose to simply go through this process on their own without an attorney, but the truth is these individuals are more likely to get rejected. Then, all of the time and effort only results in the loss of benefits that they could have gotten if a few things were better addressed.

There are some advocates that offer some support, but be careful because some of these individuals are not as savvy. In fact, they may actually charge similar fees as though they are a lawyer, even though they are actually less qualified. Don’t waste time and money, get things handled right the first time and as quickly as possible. Find a qualified LTDI Denials attorney now.





Author: Marc Whitehead

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