If your Long-Term Disability claim was denied you know how difficult it is to obtain these benefits. At Ascend Disability, our team of experienced Oklahoma long-term disability lawyers know this and are dedicated to helping you secure what you are entitled to.
More often than not, insurance companies take advantage of people who seek long-term disability benefits alone and that’s why you need the best legal representation. We know your disability has changed your life, but you should not have to fight with an insurance provider as you try to recover and rebuild it. We are here to help and all you have to do is make the call (855) 445-9787!
What is Long-Term Disability?
Long-term disability (LTD) insurance is a form of coverage that provides income to employees who are not able to work for an extended period due to a sustained injury or condition.
Some individuals can survive for a few months without income, but if they suffer an injury or condition that stretches out for a long time, it can take a toll on their finances and ability to make a living. LTD insurance is designed to help prevent this.
Long Term vs Short Term Disability
There are two forms of disability insurance available to workers: long-term and short-term. Short term a form of coverage that pays a certain percentage of an individual’s salary if they are temporarily unable to work due to an injury or illness. If the employee is still unable to return to work due to the disability (usually 6 months), long-term disability insurance takes over, covering between 50 to 60 percent of the individual’s salary.
Policies surrounding LTD are measured in years and the benefits last until the person can resume work, or for the number of years stipulated in the policy. The shorter the time window, the cheaper the policy. Disability insurance often costs between 1 to 3 percent of an employee’s salary and when purchased through an employer, the benefits are taxable. However, this does not apply to private insurance policies.
What are the Requirements for Long-Term Disability?
Qualification for LTD is usually determined by a combination of factors such as medical history, age, ability to do essential job tasks, and physical and mental status. In Oklahoma, you’re required to provide proof of your injury or illness to the insurance provider, showing that it hampers your ability to work and meets your policy’s classification of disability.
Proof of Disability
Your insurance provider will ask you to provide medical documentation and other evidence relevant to your claim. This process is stipulated under the section known as ‘’Proof of Claim’’ in your insurance policy. You’re required to notify the insurance carrier and submit the required paperwork to file a claim.
The claims process can be quite arduous, taking anywhere from several weeks to months to complete. That’s why it is best to involve a seasoned LTD lawyer.
Definition of Liability
The insurance provider will also assess your ability to continue working in the same position or in a varying capacity, depending on your work duties and work history. The policy should outline the definition of an LTD, which is usually based on if you can work in your ‘own occupation’ or ‘any occupation’.
- Own Occupation- This means that you’re disabled and cannot perform the duties of your current job. This is usually based on how the job is defined nationally, and not by your employer. Under most policies, this coverage lasts up to 2 years.
- Any Occupation- After the first 2 years, the disability is defined on a more narrow level. You’re expected to show that you cannot be able to do the duties of any job, or a specific percentage of your income before the disability. Under most policies, it becomes harder to become eligible for benefits after two years.
What Medical Conditions are Covered by Long-Term Disability?
In order to give guidance on conditions that are eligible for disability benefits, the Social Security Administration (SSA) provides a manual known as the Blue Book. This stipulates the impairments deemed to be severe enough to prevent an individual from doing any gainful activity despite their education, age or work experience. The manual is divided into the following sections in accordance to body systems:
- Musculoskeletal Systems like soft tissue injuries and back injuries
- Respiratory disorders like cystic fibrosis
- Special senses & speech like hearing and vision impairments
- Digestive system like chronic liver disease
- Skin disorders like dermatitis and chronic skin infections
- Cardiovascular system like chronic heart failure and congenital heart disease
- Hematological disorders like bone marrow failure and anemia
- Genitourinary disorders like kidney disease
- Mental disorders like autism and schizophrenia
- Congenital disorders like non-mosaic Down syndrome
- Neurological disorders like muscular sclerosis and cerebral palsy
- Immune system disorders like HIV, rheumatoid arthritis and lupus
- Cancer like lymphoma and skin cancer
- Endocrine disorders. These entail conditions that cause hormonal imbalance.
What is the Long-Term Disability Process?
When it comes to claiming LTD benefits, there’s a process that you should follow to ensure that everything happens in accordance with the law and that your claim is not denied. These essential steps include:
Notify Your Employer
It is imperative that you make your employer aware that you will not be able to perform your duties as a result of the disability. You may qualify for temporary leave under the Family & Medical Leave Act (FMLA). Also, it’s important to notify them that you intend to apply for LTD. That’s because some insurance providers require employers to make an employer statement following the incident.
Check the Time Limits on Your Policy
Next, you will want to check your policy’s deadlines for a long-term disability benefits claim. Keep in mind that if you fail to file within the time limit, there is a high possibility your claim will be denied.
Check the Policy’s Definition of a Disability
Next, you will want to go through your policy in order to determine its specific definition of a disability. Keep in mind that some policies require an individual to be completely disabled to qualify for long-term disability benefits, while others require them to be just partially disabled. A lawyer will come in handy in determining whether you have a solid case in this regard.
File an Employee Statement
This process slightly varies depending on the insurance provider, but most carriers will require you to file an employee statement. This document should include the basis of your information, medical information, place of work, the practitioner providing primary care, any workers’ comp details, etc. Again, you should check the deadlines for doing this on your policy.
Seek Medical Attention & Garner Evidence
It is advisable to apply for long-term disability benefits soon as your physician determines your condition is too severe to prevent you from working. This is usually within 3 months or less from when you halt working.
Medical evidence collection is one of the most imperative aspects of your long-term disability application because if it is not adequate enough to substantiate your claim, you’re not likely to qualify for benefits. When you meet the doctor, ensure you explain all aspects of your situation and be honest. They are required to submit evidence that showcases your condition and also why the condition limits you from going back to work.
How Can a Long-Term Disability Attorney Help?
Most of the long-term disability insurance is governed by the Employee Retirement Income Security ACT of 1974 which has very stringent procedures and time limits for filing a claim. The average individual may not be aware of these details and so, taking the case on your own is never a good idea.
A seasoned long-term disability attorney will:
- Prepare your claim for filing
- Ensure the claim file has all the relevant evidence
- Partner with medical experts to collect opinions that support your case
- Prepare the right questions and garner all the information required, rather than depending on forms provided by the insurance carrier
- Hire experts to testify about the requirements of your position as well as the overall labor market.
- Serve as your representative, communicating with the long-term disability insurance carrier or plan administrator.
- File claims and appeals in a timely fashion
- Perform settlement negotiations
- File a lawsuit if it comes to it.
Secure Your Long-Term Disability Benefits with the Help of an Oklahoma LTD Lawyer!
Don’t settle with letting insurance companies determine your well being, you are not alone and we are here to fight with you!
Our seasoned disability lawyers in Oklahoma are readily available to help you navigate this complex process. Reach out by calling our office at (855) 445-9787 and get a free no-obligation initial consultation.
