When you need to file a Long Term Disability claim, the company you have your insurance policy with makes a difference. Our Altamonte Springs Long Term Disability attorney explains.
Long Term Disability (LTD) insurance protects individuals from loss of income after a debilitating illness or injury. If you cannot perform your work duties, having financial benefits from your LTD policy is crucial. Working with the insurance companies, however, can be difficult, which is why you should get help from an experienced Altamonte Springs Long Term Disability attorney right away if you are thinking of filing an LTD claim.
Herbert M. Hill, P.A. has vast experience with all the major insurance companies, and we would like to offer you some insight into how these companies work to approve or deny claims.
What Do LTD Insurance Companies Do?
Insurance companies that offer Long Term Disability policies often provide them through your employer as group policies. They also offer individual policies for those who are self-employed or do not work in places where Long Term Disability insurance is available. What these companies have in common is that they all base their claim decisions on whether the claimant has suffered a loss of income based on their illness or injury.
Each company uses different language in its policies, and the wording makes a huge difference in how your claim is processed and if benefits will be awarded. LTD policies can be lengthy and confusing without the legal help of a skilled Altamonte Springs Long Term Disability attorney like those in our law office.
The role of insurance companies is to gather evidence related to your LTD claim and then determine if that evidence justifies approval for benefits. Although many initial claims are denied, LTD insurance companies must make their decisions in good faith and be fair when determining whether a claim will be approved.
Employee Retirement Income Security Act (ERISA)
ERISA is a federal law primarily governing employer-sponsored benefit plans, such as pension and health insurance plans. It has a significant impact on insurance companies and claimants. For claimants, ERISA provides protections and standards for filing and appealing benefit claims, ensuring a fair and consistent process.
It also allows claimants to get help if they have problems with insurance companies.
If your LTD policy is subject to ERISA, having an LTD attorney guide you through the claims process will be highly beneficial.
Long Term Disability Eligibility
Whether you meet the standard of eligibility for LTD benefits depends on many variables, including the wording of your policy and how your insurance company handles claims. Other eligibility requirements can include:
- Time worked – Your insurance policy will specify the number of hours worked per week required to qualify for Long Term Disability benefits, as well as the number of “credits” needed for eligibility. These credits are determined by the duration of your employment and your contributions to the LTD policy.
- Pre-existing conditions – Though the Affordable Care Act prohibits disqualification based on pre-existing conditions, claimants who experience a disability within the first one to two years of the start of coverage, resulting from a condition previously treated, diagnosed, or strongly suspected right before the start of coverage, may not qualify for benefits.
- Medical qualifications – The claimant must have a documented medical condition that adversely affects their ability to work.
- Earnings analysis – A diagnosis alone generally does not qualify you for benefits. Your insurance company can perform an earnings analysis to determine if your diagnosis has a significant effect on your ability to perform your (or any comparable) job.
- And others
An Altamonte Springs Long Term Disability Attorney Can Work With Your Insurance Company To Support Your Claim
When you file your initial LTD claim, having an attorney help you gather all the necessary information and documents will increase your chances of being approved. The process is complex, and if you leave anything out, the insurance company can deny your claim.
If your claim has already been denied, our team at Herbert M. Hill, P.A. can guide you through the appeal process. Our experience with insurance company practices equips us to advocate effectively for your case and work towards a favorable outcome. Contact us today for a free case evaluation.