Long term disability coverage is a provision included in some insurance benefits packages which will pay an employee a significant portion of their salary in the event that they become unable to work because of a lasting disability. This disability may be caused by an accident on the job or, in some cases, by an event unrelated to work. However there are restrictions for pre-existing conditions.
There is, however, a large burden of proof on the individual employee to show that they are indeed disabled and that they are entitled to make a long term disability claim. It is important to note that you must satisfy the definition of “disabled” that is outlined by your insurance company, not your own personal definition of disabled or a doctor’s definition.
If you get your insurance through your Massachusetts employer, you can ask a human resources representative for the information within the insurance policy that defines what a disability is. Insurance policies generally pay out long term disability claims for people who are “totally disabled,” meaning you are wholly unable to perform your work duties because of your disability, but some policies will pay for “partial” disabilities as well.
Proving a disability
In proving to an insurance company that you are indeed disabled in the long term and unable to work, the most crucial factor is getting a thorough and verified testimonial from a doctor who has observed and treated you, and knows the specific circumstances of your disability.
Insurance companies are, obviously, inclined to not just hand out expensive long term disability claims, and so it is crucial to make sure that a reliable doctor can provide a truthful and detailed account of your disability. How did you get it? How does it debilitate you? How did the doctor diagnose the disability? What tangible proof can the doctor show that your disability has a serious impact on your ability to work (x-rays, MRIs, surgery reports, etc.)?
Another important aspect of long term disability claims is that you must be receiving ongoing treatment to deal with your disability. Even after a claim has been deemed successful, it is important to continue to show that the benefits you are receiving are needed and are going to the cause they are intended to go towards, otherwise the insurance company may have grounds to terminate the benefits.
To receive benefits, usually an employee must have been a full time employee at the time of becoming disabled. Employees will have to go through a waiting period of usually a few months, and may be required to use up sick time and short-term disability benefits before applying for a long term disability claim.
Before applying for long term disability coverage, you should be sure that the injury/disability you suffered if covered by the policy, and is not expressly excluded from coverage. Certain jobs that require dangerous tasks may have more exclusions involving work-related injuries than less dangerous jobs.
In addition to long term disability, you may also be eligible for Social Security Disability benefits and workers’ compensation benefits (if the disability occurred as the result of a workplace injury).
The only way to know for sure what benefits you are eligible for, and how much you may be able to collect, is to consult with a knowledgeable attorney. At Altman & Altman LLP we have over 40 years of experience helping people navigate complicated insurance issues in order to get the money they are entitled to. Call us for a free consultation today at 617-492-3000 or toll-free at 800-481-6199. We are available 24/7.