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Long Term Disability: Applications, Claims and Denials
Long Term Disability (LTD) benefits provide critical financial support when an injury or illness prevents you from working. Generally, these benefits begin after your Short Term Disability benefits end, bridging the gap to ensure ongoing income replacement. The Herbert M. Hill, P.A., team is your Long Term Disability attorney Orlando. We are committed to making the transition from Short Term to Long Term Disability as seamless as possible.
Even if your Short Term Disability claim was denied, it does not necessarily mean your Long Term Disability claim will be. It is essential to pursue your LTD claim, as it involves different qualifications and definitions of disability. We specialize inhelping clients understand their policies and protect their rights, ensuring they receive the benefits they deserve.
What Are Long Term Disability Benefits?
Long Term Disability benefits typically replace a percentage of your pre-disability earnings when you cannot work due to illness or injury. These earnings are often calculated based on your base salary and may exclude bonuses, commissions, or overtime unless otherwise specified in your policy. Understanding these nuances is critical to maximizing your benefits.
As your trusted Orlando Long Term Disability attorney, we have extensive experience interpreting policies, from understanding how “pre-disability earnings” are defined to addressing exclusions and limitations often hidden in the fine print. We are dedicated to helping clients navigate these complexities.
The Difference Between Short Term and Long Term Disability
While Short Term Disability (STD) provides immediate income replacement for temporary conditions, Long Term Disability benefits are meant for extended periods of incapacity. A common misunderstanding is assuming that denial of STD benefits automatically affects eligibility for LTD benefits—this is often not the case.
LTD policies usually provide coverage for a longer duration, often until retirement age or until you can return to work. Each policy defines disability differently, and meeting the requirements outlined in the LTD plan to qualify is crucial. Whether transitioning from Short Term to Long Term Disability or applying directly for LTD, your Long Term Disability attorney in Orlando will guide you through the process.
How to File a Claim for Long Term Disability Benefits
Filing a claim for Long Term Disability benefits can be daunting, especially when understanding what information is required and how to present it. It is essential to gather the following to strengthen your claim:
- Comprehensive medical documentation supporting your disability
- Records from your employer outlining your duties and responsibilities
- A clear understanding of how your LTD policy defines disability
The sooner you apply, the better. We recommend initiating the claim process before your Short Term Disability ends, if possible, to ensure no gaps in benefits. As your experienced Long Term Disability attorney, we will help you compile the necessary paperwork, present a strong case, and ensure no details are overlooked.
Why Are Long Term Disability Claims Denied?
Despite submitting a thorough claim, your Long Term Disability claim can still be denied. Common reasons for denial include:
- Insufficient medical evidence: The insurer may claim insufficient proof of your disability.
- Failure to meet the policy’s definition of disability: LTD policies often require claimants to be unable to perform the duties of their “own occupation” for a certain period, after which the standard shifts to “any occupation” they can reasonably perform.
- Pre-existing condition exclusions: Some policies deny claims related to conditions present before the coverage period began.
As your knowledgeable Long Term Disability attorney, we have extensive experience dealing with every major insurance company. This allows us to quickly identify the issues that led to a denial and develop a plan to overcome them. We specialize in building strong appeals, so a denial is not the end of your claim.
Long Term Disability Appeals Process: Fighting a Denial
If your claim has been denied, it is critical to act quickly. Most Long Term Disability policies governed by ERISA (Employee Retirement Income Security Act) allow 180 days to appeal the denial. This time-sensitive process requires a comprehensive understanding of your policy and new and updated evidence to support your appeal. The steps of the LTD appeal process include:
- Review of the denial letter: Identify why your claim was denied.
- Collection of additional medical evidence: Work with your doctors to obtain updated medical records or reports.
- Preparation of a detailed appeal letter: Address the reasons for the denial and provide supporting documentation.
Your Long Term Disability attorney will assist you in every step of the appeal process, ensuring your case is as strong as possible. Appeals often result in overturned denials but winning takes skill and persistence.
Common Challenges in Long Term Disability Claims
Long Term Disability claims come with a variety of challenges. Understanding the intricate details of your policy and how insurance companies operate is critical to overcoming them. Some common issues include:
- Definition of “earnings”: Policies may exclude overtime, bonuses, or commissions.
- Definition of “disability“: Policies often require you to meet specific definitions, such as “own occupation” or “any occupation.”
- Overpayment and offset issues: Insurers may reduce your benefits if you receive income from Social Security, Workers’ Compensation, or a pension.
- Mental or nervous limitations: Some policies limit the duration of benefits for mental health conditions.
- Self-reported symptoms: Conditions like chronic pain or fatigue may be more challenging to prove without objective medical tests.
At the Law Office of Herbert M. Hill, your trusted Long Term Disability attorney, we have successfully navigated these challenges for clients, ensuring they receive the benefits they are entitled to. Our knowledge of the major insurance providers and the common pitfalls of their policies gives us the upper hand in handling these disputes. Contact us today to discuss your claim.
Testimonials
Unfortunately, my medical condition forced me to stop working. After applying for Long Term Disability benefits through coverage I had with my employer, I was forced to look for representation. No attorney would take my case until I consulted with and hired Herbert M. Hill, P.A. to enforce my rights. It was an excellent decision. Mr. Hill and staff worked promptly to appeal the benefit denial. The appeal was successful and I have been on benefits ever since. After that, Mr. Hill kept my file open. His firm has handled all paperwork and walked me through each issue which came up.
I am a former manager of a well known telecommunications company. After many years on a successful career path, my health conditions forced me to file for Long Term Disability benefits. Although it seemed to me that I was clearly disabled, the insurance company denied my benefits. It was at this time that I decided to employ the services of Herbert M. Hill, P.A. to assist me with the claims. I am glad I did.
At any given time, I knew where my case stood. If I had any questions, they would be answered on my first call or by the end of the same day.
The case was handled efficiently and in a timely manner. I have and will continue to recommend Mr. Hill.
The undersigned is a veterinarian whose health conditions forced me to file for disability benefits, including benefits pursuant to an “overhead” policy.
There were any number of issues which arose, none of which I would have expected. Mr. Hill even came to my office for a review of my office procedures and a meeting with the insurance company’s field representative.
The assistance provided by Mr. Hill and his staff proved invaluable, even continuing with related issues which have continued to arise after my disability claims were approved…
I am extremely grateful for the personal concern shown – not only about my claims but about me – his staff’s concerns as to how my claims and the issues relating thereto would affect me, as a person.
Mr. Hill filed an appeal which resulted in an early settlement of the ensuing lawsuit which was the result I wanted. Because of the successful handling of that claim, I retained Mr. Hill to handle an issue which arose in conjunction with my entitlement to continuing pension benefits. Mr. Hill again filed an appeal which resulted in those benefits being reinstated.
I was very pleased with not only the favorable results secured as a result of Mr. Hill’s representation but also the manner in which he handled the claim and kept me advised throughout the proceedings.