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Important Tips

Tip #1
Be aware of your particular terms of disability coverage to avoid pitfalls. Insurance companies often misrepresent your medical conditions and mislead you so they can use that information to deny benefits later on – often after 24 months.

Tip #2
Be truthful and thorough when you present your medical conditions, especially if you have co-morbid or multiple conditions.

Disability Insurance Claims (Benefits)

Disability insurance is income protection if you become disabled and unable to work. Insurance companies, such as Cigna, Unum, Prudential, or Hartford to name a few of the major carriers, sell disability coverage. Most people that have this type of insurance have it as part of a group policy through their employment. Some professionals choose to purchase individual policies for more selection in terms and coverage. Some policies will have short-term disability benefits but not long-term disability benefits, or vice versa, or they will have both.

Every year, millions of American become disabled from chronic illness, life-threatening diseases or accidents that make them unable to work. If you’re in this situation and unsure if you have Disability Income Insurance, you should contact your employer to find out if you have short term and/or long term disability coverage and obtain a copy of your policy. All policies vary in terms and coverage. With so much riding on the ability to maintain an income, the smartest first step is to fully understand your disability insurance policy.

We understand how important disability benefits are if you become disabled. Our disability attorneys have experience with every major insurance company and are here to help you.

Short Term Disability Insurance (STDI)

Short term disability coverage is meant to temporarily pay either all or a percentage of your income while you are recovering from pregnancy, surgery, or other medical conditions that disable you from working on a short-term basis, typically up to 26 weeks.

Often short term disability is the gateway in your journey to receive long term disability benefits. In fact, under some policies, exhausting short term disability benefits may be a requirement before you can apply for long term disability benefits.

IMPORTANT TIP: If your short term benefits have been denied, there are often shorter timelines for appealing and seeking relief through the courts. It is not uncommon for insurance companies to deny or terminate short term disability benefits before the end of 26 weeks as a tactic to hinder the ability to apply for long term benefits. Do not delay speaking with an attorney about short term disability benefits as it could safeguard you from being prevented from submitting a claim for long term disability benefits you may otherwise be eligible for.

Long Term Disability Insurance (LTDI)

Unlike short term coverage, long term disability insurance pays a monthly benefit if your illness or injury prevents you from working long term. Typically, this is a percentage of the income you earned when you were able to work. Many policies define Disability by requiring you to be unable to perform the material and substantial duties of your Own Occupation for a period of time, often 24 months.

To receive benefits until retirement age, you must be unable to perform the duties of Any Occupation based on your reasonable training, education, and experience. Sometimes, there is a loss of earnings provision that accompanies the definition of Disability. Commonly, long term disability policies require you to be under the regular care of a physician, and they limit the length of time you can receive benefits for certain medical conditions, such as for mental nervous conditions.

If you have a long term disability claim, disability insurance companies will request your medical records and ask you to complete disability forms and provide other information. Your treating providers will be asked to complete the Attending Physician Statements. Often your insurance company will send you for cross examination by their doctors and surveille you with and without your knowledge to capture activity to try to disprove your disability.

It is important to know your rights as insurance companies are notorious for oversimplifying the process and using delay tactics to deny or terminate your long term disability claim despite all the premiums you or your employer paid for disability insurance to be there in case you need it. We understand how difficult it is to face these issues while also dealing with being disabled. Let our experienced LTD lawyers fight for the benefits you need and deserve so you can focus on your health.

Laws that Govern Disability Policy Claims

Most disability income insurance claims are governed either by ERISA or Insurance Bad Faith laws, whether it is for short term or long term disability appeals or litigation. Do you have an individual disability insurance policy or group disability insurance through your employer? Who is your employer, and what was the nature of your job? Who paid the premiums?

These questions, along with many others, determine the law governing your disability benefits. Virtually all disability policies are subject to the federal statute ERISA or State law which Insurance Bad Faith falls under. Determining which law applies to your disability benefits is critical, because doing so impacts your rights, responsibilities, and the relief you can hope to receive.

State law typically governs individual disability insurance policies whereas the federal statute ERISA commonly governs benefits offered through an employer. Disability benefits offered through your employer are generally referred to as group insurance. Disability benefits you independently purchase through an insurance agent or perhaps through an organization where you are a member, are referred to as individual disability insurance policies. Accountants, attorneys, doctors, or other professionals who buy policies by virtue of membership in professional organizations, are usually governed by State law or Insurance Bad Faith.

Ober Pekas Ronstadt has focused exclusively on disability benefits law for more than 30 years. Our LTD attorneys are highly experienced in ERISA and Insurance Bad Faith and have secured millions of dollars in disability benefits. Rest assured we can help you too.

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