General Requirements for Filing Long-Term Disability Insurance Claims

It can be overwhelming to know everything you need to know before filing a long-term disability (LTD) insurance claim. Therefore, we here at Rosen Moss Snyder LLP broke down the key pieces to try to make it a little bit simpler for you.

Essentially, there are many obstacles to overcome before being approved for LTD, including proving, with medical evidence, that you meet your insurance policy’s interpretation of disability. However, there are additional requirements including waiting periods, premiums, and a minimum number of hours worked to adhere to for LTD benefits.

Here’s a brief breakdown:

  • Proof. Proving that you are actually disabled can sometimes be a challenge. Contacting a Philadelphia area ERISA disability attorney can make all the difference. If you’re considering filing for LTD, first consult the summary plan in your policy or ask your employer’s HR department what its exact definition is of disability. Typically, you will be found “totally disabled” if you are unable to perform the duties of your job due to illness or injury. Some policies provide partial disability where you can’t work full-time at your occupation, even if you are able to work full- or part-time at another job. In some cases, the policy does not allow for an LTD claim if you are still on the payroll of your current employer. In many instances, the most important factor in proving your claim is the opinion of the doctor who is treating you. Your doctor will be required to give a written statement on your condition, in his or her opinion. Although this “doctor’s note” is critical, most claims administrators want objective proof of your disability, which often leads to a request for all related medical records, clinic notes, tests, and more. To show that a disability is ongoing, you should continue to receive treatment from your doctor while your claim is pending and even after you are approved, in order to avoid grounds for termination of benefits.
  • Full-Time Employee. Most LTD plans require that you work for the employer full-time when you become disabled, generally putting in at least a 30-35 week.
  • Waiting Period. Often stretching between three to six months, the “elimination period” on most LTD policies is the time from when your disability occurs to when you can begin to receive benefits.
  • Pre-Existing Conditions. Many policies exclude pre-existing conditions which generally is considered an illness or injury that is diagnosed or treated within 90-180 days before LTD coverage begins. These pre-existing conditions can disqualify you from receiving LTD benefits.
  • Excluded Conditions. Some policies have exclusions for certain diseases or workplace accidents and therefore will not receive approval for coverage. Also, sometimes a LTD plan contains a 24-hour limitation on disabilities caused in part by alcoholism, drug abuse, and mental/nervous conditions.

To navigate through the often confusing and sometimes stressful LTD process, contacting and consulting with a Philadelphia area ERISA disability lawyer will help cut through the red tape and bring peace of mind to the entire process. Call 215-458-2519 to get help with your LTD needs and allow you to sleep better at night. You won’t regret it!

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