Our law firm frequently engages in free legal consultations by phone with individuals who are currently struggling to continue working in his or her occupation due to a disability. The concerns and questions are typically the same: How do I notify my employer that I can no longer continue working? How do I know if I have group short-term disability or long term disability coverage? How do I file applications for benefits? Can I also file claims for short term disability benefits with my state? Can I be fired by my employer while out of work due to a disability? How long does it take to get a decision once I file my claim? The questions are many. The answers to those questions can vary and be complicated. We understand it may be overwhelming. Please know we are here to help and we can start to help by offering you the general information below.
How to Fill out Your LTD Application
First, we highly recommend that you request copies of your insurance coverages from your employer’s human resource specialist or department – more specifically, we recommend that you obtain copies of your short term disability coverage, long term disability coverage, and any voluntary disability insurance coverage that you are enrolled in and eligible to receive. You should request full, complete copies of your plan or policies. These documents are typically 20 to 30-pages in length and are much more detailed than the 5 to 6-page summary plan descriptions that may also be available, but you will want the full, complete copies of the policies. It would also be beneficial to learn the “effective date” of each disability insurance policy you are covered by. This date will tell you when you first became covered (or insured) by the policy. If you are worried to raise concerns with your employer’s human resource department by requesting a copy of your disability coverages, you may want to consider requesting a copy of all employee benefit plans, coverages, and benefits, which should include any disability coverages.
Second, we gladly offer free legal consultations to help disabled individuals get answers to general questions or basic guidance that he or she may need before or during the application process for disability insurance benefits. More often than not, we recommend that a disabled individual file his or her application without the assistance of an attorney unless there are specific reasons why that person should consider using an attorney from square one. Some examples of situations that may require legal representation from an experienced long term disability insurance lawyer from the start of that process are below:
- An application for long term disability benefits due to a chronic medical condition. Too often we are encountered with a situation where a good, hard-working person suffering from a chronic medical condition for years or decades gets to a point where he or she could no longer continue despite that person’s best efforts and the long term disability claim administrator questions the claim for that very reason. Rather than credit the person for continuing to work in the face of adverse medical conditions, the insurance company takes the position that the claimant’s ability to work with the disabling medical condition prior to the work stoppage is proof that he or she is not disabled. An experienced disability insurance lawyer can help you navigate the complexities of a claim based on chronic medical conditions where you may require help mitigating or avoiding the negative inferences and assumptions of an insurance company reviewing when or if your chronic medical condition became disabling per the terms of the policy.
- An application for long term disability benefits filed with a date of disability that is within the first 12 months of the policy’s effective date. Many group long term disability insurance policies have “pre-existing condition limitations.” The specific terms of each policy can differ, but most explain that if the disabled person goes out of work within the first twelve months after the disability insurance policy’s effective date, the insurance company will investigate if the disabling medical condition was in existence or being treated prior to the effective date of the policy – usually within the three months prior to the policy’s effective date. If this sounds confusing, that is because it can be if this is your first time filing a disability claim, which is the case for most people. The best advice we can offer you is to obtain copies of your disability insurance policies and consult an experienced long term disability attorney if you were or will be forced to stop working within 12 months of the start of your disability insurance coverages. \
- An application for long term disability benefits based on both physical and mental health impairments. It is extremely common for disabled individuals to suffer from both physical and mental health impairments – and understandly so. A disabled worker’s health, career, financial well-being, and familial/social relationships hang in the balance once that person is unable to continue working, which can have a ripple effect across a person’s physical and mental health. Filing claims where both physical and mental impairments exist can be more complicated depending on the specific terms of the long term disability insurance coverage due to limitations that can apply to both specific physical conditions, like MPS (Myofascial Pain Syndrome) and broad categories of mental health impairments.
- A long term disability application process complicated by a situation in which your treating provider explains that he or she does not, as a general policy, complete disability paperwork. One fundamental aspect of a claim for disability insurance benefits is providing a medical opinion from your treating medical provider that specifies your restrictions (things you should not do) and limitations (things you cannot do) as a result of your medical impairments. Not all doctors are willing to complete these functional capacity forms, which often have titles such as Attending Physician Statement, Physical Ability Assessment, Behavioral Health Capacity Questionnaire, etc… This can leave the disabled worker in a tremendously difficult situation, especially where the insurance company has a large inventory of physicians who will never examine you, limit his or her review to your paper records, and gladly provide an opinion about what you can and cannot do in return for payment from the disability claim administrator or insurance company.
- A long term disability application following a short term disability claim that was reviewed frequently and extensively. If your short term disability claim was reviewed frequently and extensively, or possibly even suspended on a few occasions pending your submission of additional evidence, and you are now transitioning to a long term disability claim with the same claim administrator or insurance company, you could be facing a long term disability application review process that will scrutinize your disability even further, and possibly subject to a change in terms between the STD and LTD policies. If the payment of your short term disability benefits was a struggle and you are unable to return to work necessitating a claim for long term disability benefits, you should consult with an experienced long term disability lawyer sooner rather than later.
The above are just a sampling of the situations in which a person may require experienced legal representation from “square one” to help the disabled individual maximize his or her chances of success, which could avoid a lot of delay, financial loss, and limit attorney fees and costs that could be involved with fighting a denial or termination of benefits. There are certainly other types of complicated situations that may require experienced legal representation from the start of a claim so you should consult with an attorney if you have specific or general questions.
Overall, the long term disability application process is very much a “Do not pass Go, do not collect $200” Monopoly-type situation. Our involvement in long term disability applications is helping disabled workers pass “Go” per the specific terms of that person’s policy.
Get Legal Help With Your LTD Application
Please understand that Capitan Law can never guarantee success (nor can any lawyer for that matter), but we do our best to help protect our client’s best interests based on his or her particular situation. Please contact us to schedule a free legal consultation if you would like to discuss your disability insurance coverage and long term disability application.
