For a family that is struggling to pay the bills after an injury or serious medical condition, long-term disability benefits (LTD) can be the lifeline that is needed to weather the storm. LTD benefits can help to pay rent or mortgage payments, groceries, and other essentials. So, when an insurance company refuses to pay LTD benefits, it can leave people in a really bad situation. There is often not a lot of time to take action, and quite frankly, the law does not give disabled workers much room for error.
That is why at Burke Harvey, LLC, we offer free consultations to all potential clients who are seeking to get help with their LTD benefits. Here are seven of the most frequently asked questions we receive regarding LTD insurance benefits?
What is the Difference Between Social Security and LTD Benefits?
Social Security is a government program, whereas LTD benefits are based on a private insurance contract between your employer and an insurance carrier. So, if you become disabled and can no longer work, you may indeed qualify for both. However, SSDI (Social Security Disability Insurance) often takes years to appeal. LTD benefits through your employer’s benefits plan is designed to kick in relatively soon after you are diagnosed with a qualifying condition. In fact, this is precisely why millions of Americans pay into these programs each payday through payroll deductions.
How Much Does an LTD Plan Pay?
This depends on the plan you purchased. Most of the time, people will get a choice of two or three options when they are first hired. The plan will cover a percent of your income for each pay period up to a specific number of months. In general, you pay more for longer benefits periods or higher percentages. To find out your precise eligibility amount, you will need to refer to your individual policy materials. A lawyer from Burke Harvey, LLC may be able to help you review your policy to learn more about your unique options.
When Does LTD Start Paying?
In most situations, LTD should kick in as soon as any applicable short-term disability plan runs out. STD and LTD benefits work in tandem to make sure an injured or otherwise disabled employee receives some income replacement immediately (STD benefits), then once the condition is deemed to satisfy the requirements for LTD, the LTD benefits should kick in. This is why many LTD benefit plans have a 30 or 60-day waiting period before they begin to pay out.
Is it True You can Not Sue Your Own Insurance Company in Alabama?
No. While it is difficult to bring a lawsuit against an insurance company in most states, including Alabama, it is not impossible. In fact, if the insurance company’s denial is “arbitrary and capricious,” you may be able to sue for “bad faith.” This is a legal term that just means the insurance company had a contract and intentionally violated it in such a way that it hurt a policyholder.
What is the Deadline to File an Appeal?
Each policy is a unique contract document that will set forth the amount of time you have to appeal. Because LTD benefits are underwritten by private companies, there can be a wide range in time periods. However, under the Employee Retirement Income Security Act (ERISA), most large employer plans will give you just 180 days to file an appeal with the insurance carrier. This starts with your denial. But beware, not all plans are governed by ERISA, and some could have deadlines as short as just 60 days.
What Happens if I Miss a Deadline?
When it comes to private contracts, the government does not like to get involved. So, when it does, it is with strict limitations. Under ERISA, certain guidelines are put in place to protect disabled workers, but as long as the insurance company meets its legal obligations regarding proper notice, it is very important to meet the deadlines. If you fail to do so, then you will lose your right to pursue an appeal in court. Missing a deadline can destroy your chances of getting compensated, even if your claim is perfectly valid.
What are the Steps to a Long Term Disability Appeal?
The steps to getting your LTD benefits are as follows:
- Initial application: Make sure you get all the proper medical evidence and documentation together the first time. You will not likely be able to submit additional information later.
- Denial or Approval Letter: You will receive a letter from the insurance company with their decision. If it is a denial, you must carefully read your policy to determine the deadline and procedure for appeal.
- Appeal: Depending on your insurance plan, you will need to file a written appeal of the denial.
- Second Denial: You will eventually receive a final determination, which will either approve your benefits or deny them.
- File a lawsuit in Court: If the insurance company rejects the appeal or denies you again, and you believe there is a mistake, your last option is to file a lawsuit seeking to overturn or reverse the decision on a number of legal grounds.
How We Can Help
If you have been unfairly denied LTD Benefits, call the experienced LTD insurance lawyers at Burke Harvey, LLC. We take no fee unless we succeed in getting you benefits, and all consultations are free.