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Requirements For Filing A Long Term Disability (LTD) Insurance Claim

Requirements For Filing A Long Term Disability (LTD) Insurance Claim

What You Need To Know To File A Long Term Disability Claim Under ERISA:

Q.   On what day did you become a plan member?

This is very important because some plans require a waiting period before you become a plan member. The Plan may require you be employed 90 days before you become a plan member, OR your employers disability insurance plan may have kicked in the first day you were employed.

Q.   What is the definition of disability in your Disability Insurance Plan?

Disability Insurance plans have 2 periods of disability: “Own Occupation” and “Any Occupation. Each has different requirements that must be met.

Q.   Does your plan’s definition of disability require an inability to complete one, some, or all of the duties of your occupation before it will pay benefits?
Q.   Is your claim subject to any policy exclusions?

Pre-existing conditions exclusions? a pre-existing condition is classified as an illness or injury that was diagnosed and/or treated within a certain period (often 90 or 180 days) before your LTD coverage began. If such a condition is present, you will not be paid benefits for any long-term disability that arises from that pre-existing condition for the first twelve months of your LTD coverage.

Or excluded medical conditions?  Some policies have exclusions for particular diseases or conditions. Also, many LTD policies contain a 24-month limitation on disabilities caused in part by alcoholism, drug abuse, mental conditions or nervous conditions.

Q.   How long will it take for me to get my Long Term Disability Benefits?

There is a period of time called the Elimination Period, usually three or six months, before benefits kick in. That period would be covered by short-term-disability if you have it. You’ll probably be required to use up all your sick time before filing for short-term disability, and then exhaust all short-term disability before filing for LTD.

Once the short-term benefits expire (generally after three to six months), long-term disability insurance pays a percentage of your salary, usually 50 to 60 percent, depending on the policy.

Q.   How long will LTD benefits last?

The benefits from employer provided group disability plans usually continue until you are able to return to work, OR age 65, OR your retirement age under Social Security, OR for the number of years stated in the policy. Every policy is different.

If You Need To File A Long Term Disability Claim:

Check the summary plan description in your long-term disability policy for the precise definition of “disability” (You can get this from your HR Department).

Generally, you will be found “totally disabled” if you’re unable to substantially perform the duties of your occupation.

If you’ve been denied Long Term Disability Insurance benefits, call Call (877)-428-9806 today for a FREE evaluation of your claim. We’ll be happy to discuss your questions and concerns.

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