Long-term disability (LTD) insurance provides benefits if you are unable to work due to an injury or illness. Generally,are between 50 percent and 80 percent of your normal wages. Group policies can be purchased through an employer and individual policies can be purchased independently. But even the most straightforward LTD plans can be complex, and each one is different. If you are unable to work and considering filing an LTD claim, the following information will help you determine how to move forward.
A skilledcan help you examine your group or individual LTD policy to see what benefits and limitations to expect. For starters, each policy has its own definition of the term “disability,” and your disability may or may not be covered. Further, some disabilities qualify, but with specific limitations. For instance, many insurance companies cap benefits for mental health conditions at 24 months. However, there may be exceptions for chronic and particularly severe conditions, such as schizophrenia.
Own Occupation vs. Any Occupation
Once you’ve determined that your disability is covered by your LTD policy, you must consider whether your policy falls under the category of “own occupation” or “any occupation.” Own occupation refers to an inability to perform the duties of your regular occupation, whereas any occupation refers to an inability to perform the duties of any job. Own occupation is less strict: you will receive benefits if you cannot do your current job, even if you can do another job in its place.
On the other hand, “any occupation” benefits will not be received unless you are unable to perform any job. For instance, if you can no longer deal with the physical strain of a construction job, but you can do a desk job, an any occupation policy would not provide benefits. Many policies switch from own occupation to any occupation after a set time period, typically 24 months.
Waiting Periods and Exclusions
Most policies exclude pre-existing conditions, which means that any medical condition for which you’ve been treated in the past 90 days will not be covered. LTD policies also generally contain something called an “elimination period,” during which you are disabled but no benefits are available. It usually lasts between 90 and 180 days. Short-term disability (STD) benefits are intended to bridge this gap.
As stated above, every LTD policy is different. Some pay benefits until retirement age, others pay for five or 10 years. In almost every circumstance, you will have to file for Social Security Disability Insurance (SSDI) before you can receive LTD benefits. SSDI is an income-based program intended to offset your LTD benefits if you qualify.
If your LTD is from a group policy (employer sponsored), you will likely have to pay taxes on any benefits you receive as group policies are usually purchased with pre-tax dollars. If, however, you have an individual plan, you may have purchased it with after-tax dollars, in which case your benefits will be tax free.
What if My Benefits are Denied?
Denials are actually quite common. If your initial application was denied, you can appeal the decision internally, before taking it to federal court. An experiencedcan help you appeal a denial so that you may receive the full benefits to which you are entitled.
Altman & Altman, LLP – Boston’s Premier LTD Law Firm
If an illness or injury is preventing you from working, the skilled legal team at Altman & Altman, LLP can help. We have been protecting the rights of MA workers for more than 50 years. It is our goal to get you the benefits you deserve in a timely manner so that you can get on with your life. If you have been injured, we can help.for a free and confidential consultation about your case.