Understanding Group Long Term Disability Policies: an Employee's Guide
One important benefit that many employers offer their workers is group long-term disability insurance. If an illness or injury prevents you from working for an extended period, long-term disability insurance can help you replace some of your lost income. Read on for a guide to understanding long-term disability policies offered by employers.
What You Can Receive
A typical policy will provide you with 50 to 75 percent of your salary at the time the disability occurred. The length of time you will receive payments varies depending on the specific conditions of the policy. In some cases, the time is as short as 2 to 10 years, in others, you will receive payments until age 65.
Your payments are not tied to the inflation rate unless the policy has relevant language to this effect. If your policy does adjust your benefits for inflation, the insurer will typically tie the adjustment to the government's cost of living index (COLA).
Conditions
Most policies require that you are a full-time employee who works at least 30 hours a week. Also, you need to learn if your group policy pays out when your disability does not prevent you from doing other work. Some policies pay out as long as you can't perform your current job. Other insurers may require you to take any type of work your disability allows you to perform.
For instance, if you are not able to continue doing a strenuous job such as a warehouse worker, the group insurer may demand that you take a less physically demanding job, depending on the language of the policy.
What Is Excluded
Not every condition that leads to a disability is covered by all long-term disability policies. An inability to work due to mental illness, alcoholism or drug use is not necessarily covered, or may be covered only for a limited time. Some insurers may also exclude injuries that occur in the workplace.
Another point to note is that if a pre-existing condition leads to your disability, the policy might not cover you. As a rule, a pre-existing condition is defined as a health issue that was diagnosed or treated within a specified period before your coverage started. A common time-frame for excluding a pre-existing condition is 90 days before coverage.
When to File for Disability
As soon as you become disabled, obtain a copy of your group policy from your employer Read the policy carefully to determine if your disability is covered. Long-term disability policies are quite complex, so it's a good idea to have an experienced attorney help you understand the language and advise you on how to proceed.
Contact
When you have read and understood the terms of the policy, contact the insurer and ask them about the proper procedure for filing your claim. Follow their procedure to the letter. You do not want to make any mistakes when filing that the insurer could use against you later.
What Happens if You are Denied
Many long-term disability claims are initially denied. Fortunately, you have the right to appeal a denial to an administrator at the insurance company. When you have exhausted all of your appeals and are still denied, you may then take your case to federal court.
A key point to remember is that you cannot enter new evidence at a court trial. Make certain that you present all of your evidence at the administrative appeal.
Naturally, you will want a qualified long-term disability attorney with a strong track record of success helping you at all steps of the process. Having experienced counsel at your side can definitely make the difference between a positive and a negative outcome.
To learn more about this issue, contact the team at Scott E. Shaffman Attorney at Law.
