Understanding Your Long-Term Disability Insurance Policy
Your long-term disability insurance policy is designed to replace a good portion of your income when you become disabled by accident, injury or illness and are unable to perform some or all of your usual work duties for an extended period.
Your disability must meet the criteria specified in your policy to trigger benefit payments. The amount of your payments will be based on the income you were earning at the time of your disability. The payments will continue as long as your disability continues or for the length of time specified by your policy.
At Dawson & Rosenthal, we understand how important disability benefits are for you and your family when you are not able to work. Our long-term disability claims attorneys help clients get the disability benefits they are entitled to when insurance companies don’t want to pay.
What Qualifies as a Long Term Disability?
Statistics show that 1 in 2 people will experience a disability lasting 90 days or more between the ages of 35 and 65. The most common types of long-term disabilities that people experience are more due to illness than accident or injury.
- musculoskeletal issues such as arthritis
- heart disease and stroke
- mental health disorders
Your policy will specify what you need to do to prove your disability and you will need medical verification from a qualified physician. The better the medical evidence conforms to the requirements of your long-term disability policy, the easier it becomes to get your benefits.
What You Must be Disabled from Doing
When it comes to how the disability affects your ability to work, there are two primary ways long-term disability policies are underwritten.
- own occupation – Coverage applies if you become unable to perform the responsibilities of the job you have or the profession you are currently in.
- any occupation – Coverage applies only if you are unable to perform the responsibilities of any job or profession that you are reasonably well suited for based on education and experience.
Some policies begin with coverage for an insured’s ‘own occupation’ and then switch to ‘any occupation’ after a particular length of time – often 2 years.
How Soon after Your Disability will Benefits Start?
Because long-term disability policies are designed to pay for disabilities that are going to last for a longer period of time, there are waiting or elimination periods before the payment of benefits will start. The waiting periods will vary based on the insurance plan you have.
Generally, when higher premiums are paid the waiting periods are shorter. Waiting periods are typically 30, 60 or 90 days and can be as long as a year.
What Benefit Amount You Can Expect to Receive
The amount of your monthly disability benefit can be a percentage of your monthly earnings or a fixed amount that is not based on your income. Typical policy language states the insurer will pay 60% of your monthly earnings subject to a maximum per month amount.
However, if you are receiving income or benefits from other sources due to your disability, most policies contain ‘offset’ provisions. The insurance company will deduct from your benefit amount the other amounts you are receiving until your benefits are reduced to a minimum monthly payment.
How Long Benefits Will be Paid
Benefit payment periods can be a number of years (2, 5, 10) or until a recipient reaches retirement age. A benefit period of several years is usually adequate as the average long-term disability claim lasts only about 3 years.
What to Do if Your Long-Term Disability Claim is Denied
Having your long-term disability claim denied is not the end of the story. Claims get initially denied for a variety of reasons that can be overcome by providing additional information.
There will be a period of time – typically 180 days – that you can appeal the insurance company’s decision to deny your claim. During this period you will need to find out as much as you can about why your claim was denied and provide as much additional evidence as possible in support of your claim.
The long-term disability claim lawyers at Dawson & Rosenthal know that insurance companies often deny claims because more information is needed. We get specific information about the reasons for your denial and then put together the proof – including the opinions of medical experts – necessary to get your claim approved.