Six Do’s and Don’ts When Applying for LTD
Long-Term Disability (LTD) generally provides monthly disability financial benefits when a mental or physical injury or sickness prevents you from performing your normal occupation. When your physical and financial health is on the line, you owe it to yourself and your family to make smart decisions when applying for LTD benefits. Each disability case is different, but there are some general Do’s and Don’ts that you can use to guide you on this long and often confusing path.
- File a comprehensive, detailed initial claim form. The short-term and long-term claims processes are essentially the same, which is why you need to be equally thorough when completing all of your occupational, medical, vocational disability claim forms. You need to know what injuries and illnesses qualify for LTD and for how long will my benefits last, does the policy pre-existing condition clause apply, how long does the policy pay me in “my own occupation” and does the disability definition shift to any occupation or by which I’m trained or suited. Do the research and follow up, especially on how the policy defines “offsets” and “proof of loss” requirements.
For example, your treating doctor needs to be thorough and concise on their attending physician statements, laying out your care, treatment, diagnosis, medication, testing, prognosis, and how you are restricted and limited from performing your occupational duties. If financial information regarding hourly wage, commissions, bonuses or salary is requested, supply it.
Statements from the claimant (you) and your employer are needed, and you will have to sign and date the Authorization to Obtain and Disclose Information enclosed in the claim packet.
- Respect Deadlines. The insurance carrier will contact you only so many times. When you receive a notice in the mail with details about claim requests for documentation and deadlines, act immediately. You can file for an extension if you are having difficulty meeting the deadlines especially, now, during COVID-19.
- “Don’t Operate on Yourself.” An LTD insurance policy administrator has a legal obligation to provide a detailed explanation of why a group employer sponsored disability claim was denied.
Under ERISA, you generally have a minimum of 180 days from the date of an LTD claim denial to submit a timely and comprehensive administrative appeal. You may need that time to prepare an effective administrative appeal, which will require supporting medical, vocational, and financial evidence. Whatever is supplied during the administrative appeal is all the court will later consider if the denial isn’t overturned. Hire an experienced disability appeal lawyer to perfect your claim and improve your chances of getting paid.
- DON’T publicly comment about your claim. Your claim will suffer if you post pictures or written evidence of yourself engaging in activities that a disabled or injured person should not be able to do. Just because your Facebook is private doesn’t prevent the insurance company from “friending” your friend. If you are disabled, take down your LinkedIn or the carrier will argue you are holding yourself out to the world as able to work.
Insurance providers use these seemingly fun and harmless posts as reasons to reject your claim. Activities inconsistent with your doctor’s restrictions and limitations can undermine solid, legitimate claims. So be careful!
- DON’T under-present your pain. Don’t understand your medication side effects and provide your treater with your pain scale for activities, don’t forget pan is distracting and causes lack of focus, concentration, diminished sustained attention and sleep disruption. Pain and problems make getting to sleep, staying asleep and waking up refreshed sleep impossible and leave you running on “fumes” and hopelessly fatigued.
- DON’T Wear The Lawyer Hat. Filing an LTD benefits claim is just the start of the claim process. Plan administrators may tell you that you can handle filing an initial claim or an administrative appeal on your own. Be smart. Confusing documents and further claim steps often involve laws, rules and guidelines that would vex even general practitioners.
For people pursuing long-term disability benefits, a failed attempt at representing themselves can result in missing out on the benefits they need to care for their family and maintain their quality of life. Don’t make fatal claim or appeal mistakes by “going it alone.”
These tips are just a starting point because every disability claim situation has its unique complexities, which is why decisions should not be made lightly, including when you hire a terrific disability lawyer.
If you suffer from any type of mental or physical injury or illness that prevents you from performing the important duties of your occupation, call the award-winning individual and nationally renowned group long-term disability attorneys at DarrasLaw today at (800) 898-7299 or contact us online.